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Individual

ILAXI PATEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
1850 GATEWAY DR, SYCAMORE, IL 60178-3192
(815) 758-8671
Mailing address
1850 GATEWAY DR, SYCAMORE, IL 60178-3192
(815) 758-8671

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-094572
IL
208000000X
Pediatrics Physician
036094572
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036094572
IL
01
046887
HEALTH ALLIANCE
IL
01
553180
MEDICARE GROUP PTAN
IL
01
553180036
MEDICARE INDIVIDUAL PTAN
IL
01
834340
MEDICARE GROUP
IL
01
834340024
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
08/05/2006
Last updated
05/01/2018
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