Individual
DR. JEETENDRA B PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 E MASON ST STE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Mailing address
619 E MASON ST STE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0101281934
VA
207RC0000X
Cardiovascular Disease Physician
036173952
IL
207RC0000X
Cardiovascular Disease Physician
61845
TN
207RI0011X
Interventional Cardiology Physician
0101281934
VA
207RI0011X
Interventional Cardiology Physician
Primary
036173952
IL
207RI0011X
Interventional Cardiology Physician
61845
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000662912
ANTHEM PROVIDER NUMBER
IN
05
—
200951260
—
IN
01
—
5816058-1205
UTAH MEDICAL LICENSE NO.
UT
05
—
Q060983
—
TN
Enumeration date
10/18/2006
Last updated
05/04/2026
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