Palak Patel, D.M.D
Individual provider Active NPI Dentist · Tinley Park, IL
NPI 1003476771 · NPPES record last updated Jan 15, 2021
Key facts
- NPI
- 1003476771
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019.032177 (IL)
- Practice address
- 18175 Goesel Dr
Tinley Park, IL 60487-8668 - Phone
- (708) 916-7610
- NPI assigned
- Jun 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191212001157 | IN | Order and Referring Only - Dentist |
4981037546 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019.032177 | IL | MD | Dentist |
| 12013228A | IN | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019.032177 | IL | Yes |
| Dentist | 122300000X | 12013228A | IN |
Addresses
Primary practice location
18175 Goesel Dr
Tinley Park, IL 60487-8668
Mailing address
18175 Goesel Dr
Tinley Park, IL 60487-8668
Phone (708) 916-7610
Other providers in Tinley Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.