Provider Demographics
NPI:1548250384
Name:PATEL, HIMADRI MAHESH (DO)
Entity type:Individual
Prefix:DR
First Name:HIMADRI
Middle Name:MAHESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16615 S ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-2921
Mailing Address - Country:US
Mailing Address - Phone:815-609-6300
Mailing Address - Fax:
Practice Address - Street 1:16615 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2921
Practice Address - Country:US
Practice Address - Phone:815-609-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096440207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
399980OtherGROUP MEDICAL PTAN
CAG73512Medicare UPIN
CN4921OtherRRMC
CA00AX74940Medicaid