Individual
BHAVISHA PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1850 GATEWAY DR, KISHHEALTH SYSTEM PHYSICIAN GROUP, SYCAMORE, IL 60178-3192
(815) 758-8671
(815) 758-5491
Mailing address
1850 GATEWAY DR, KISHHEALTH SYSTEM PHYSICIAN GROUP, SYCAMORE, IL 60178-3192
(815) 758-8671
(815) 758-5491
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
036140644
IL
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
036140644
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036140644
—
IL
01
—
F400321084
MEDICARE INDIVIDUAL
IL
01
—
IL6310
MEDICARE GROUP
IL
Enumeration date
07/25/2011
Last updated
07/21/2022
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