Basic Information
| Provider Information | |||||||||
| NPI: | 1073809752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | ROSHNI | ||||||||
| MiddleName: | RAMESH | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 E OHIO ST | ||||||||
| Address2: | APT 4505 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606113470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048402354 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1226 W TAYLOR ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606074709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122433769 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2011 | ||||||||
| LastUpdateDate: | 06/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | PENDING | IL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.