Individual
DR. KAUSHIK JAYANTILAL PATEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1212
(217) 366-6106
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
(217) 366-6106
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-090008
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036-090008
IL
207RP1001X
Pulmonary Disease Physician
Primary
036-090008
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036090008
—
IL
01
—
279500
MEDICARE GROUP
IL
01
—
P00892835
RAILROAD MEDICARE
IL
Enumeration date
09/02/2005
Last updated
03/07/2023
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