Individual provider Active NPI

Mukesh C Patel, M.D.

  • Obstetrics & Gynecology Physician
  • Chicago, IL
National Provider Identifier
1396739223
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
036 064813 Issued in IL
Practice address
6084 S Archer Ave
Chicago, IL 60638-2773
Phone
(773) 884-3380
Fax
(773) 884-4263
NPI assigned
Sep 7, 2005
Reactivated
Mar 30, 2006
Last updated
Mar 23, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 036 064813 IL Primary

Addresses

Primary practice location

6084 S Archer Ave
Chicago, IL 60638-2773

Mailing address

809 Saint Stephens GRN
Oak Brook, IL 60523-2567
Phone (773) 884-3380

Other identifiers 1

IdentifierTypeStateIssuer
036064813MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060502000098 IL Practitioner - Obstetrics/Gynecology 8729098124 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036 064813ILMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pathology Services Illinois, LTD Current Accepting new patients
Saint Anthony Health Affiliates Obstetrics & Gynecology CurrentSince Aug 1, 2020 Accepting new patients

Locations

2875 W 19th St
Chicago, IL 60623
Phone (773) 484-4300

4177 S Archer Ave
Chicago, IL 60632
Phone (773) 254-2222

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1396739223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 SAINT STEPHENS GRN",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605232567",
            "telephone_number": "773-884-3380",
            "fax_number": "773-884-4263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6084 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382773",
            "telephone_number": "773-884-3380",
            "fax_number": "773-884-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "MUKESH",
        "middle_name": "C",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2012-03-23",
        "deactivation_date": "2006-03-24",
        "reactivation_date": "2006-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036 064813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036064813",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.