Individual
MRS. SONAL VITHAL PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085-002512
IL
363AS0400X
Surgical Physician Assistant
10000812A
IN
363AS0400X
Surgical Physician Assistant
2695-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01618941
BLUECROSS/BLUESHIELD
IL
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147083
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
06/09/2006
Last updated
01/07/2014
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