Provider Demographics
NPI:1811779960
Name:PATEL, MAUSAM (APRN, CNP)
Entity type:Individual
Prefix:
First Name:MAUSAM
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 2060
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2994
Mailing Address - Country:US
Mailing Address - Phone:312-695-6022
Mailing Address - Fax:312-695-5672
Practice Address - Street 1:259 E ERIE ST STE 2060
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2994
Practice Address - Country:US
Practice Address - Phone:312-695-6022
Practice Address - Fax:312-695-5672
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0034821363L00000X
IL209031726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner