Provider Demographics
NPI:1619465747
Name:PATEL, SHANI (DO)
Entity type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E GOLF RD STE 211
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8821
Mailing Address - Country:US
Mailing Address - Phone:847-376-8969
Mailing Address - Fax:
Practice Address - Street 1:1400 E GOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1236
Practice Address - Country:US
Practice Address - Phone:847-376-8969
Practice Address - Fax:773-283-8688
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.169431207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine