Individual
PRAVIN-KUMAR PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 S PAULINA ST # MC588, CHICAGO, IL 60612-4353
(312) 996-9313
Mailing address
35422 EAGLE WAY, CHICAGO, IL 60678-1354
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
036-089964
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03575275
—
MS
05
—
036089964
—
IL
05
—
1000956000
—
WV
01
—
1627123
BCBS PROVIDER ID
IL
Enumeration date
09/20/2005
Last updated
01/26/2012
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