Individual
MALLIKA MODAK PATEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2650 RIDGE AVE STE 1304, EVANSTON, IL 60201-1700
(847) 570-2700
Mailing address
180 HARVESTER DR STE 110, BURR RIDGE, IL 60527-6686
(773) 702-1150
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.081303
IL
2085R0202X
Diagnostic Radiology Physician
125.081303
IL
Other
Enumeration date
12/13/2015
Last updated
05/27/2024
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