Individual
JYOTHI DEEPAK PATIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2000 OGDEN AVE, AURORA, IL 60504-7222
(314) 849-3535
(314) 849-6395
Mailing address
1050 W KINZIE, CHICAGO, IL 60642-6537
(314) 849-3535
(314) 849-6395
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
036108435
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108435
—
IL
01
—
P00305120
RAILROAD MEDICARE
IL
Enumeration date
07/10/2006
Last updated
07/03/2008
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