Provider Demographics
NPI:1043453608
Name:PATEL, RUTUJA DESAI (DO)
Entity type:Individual
Prefix:
First Name:RUTUJA
Middle Name:DESAI
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD STE 520
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1379
Mailing Address - Country:US
Mailing Address - Phone:630-938-8266
Mailing Address - Fax:630-933-7329
Practice Address - Street 1:25 N WINFIELD RD STE 520
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1379
Practice Address - Country:US
Practice Address - Phone:630-938-8266
Practice Address - Fax:630-933-7329
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.129188207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009268700Medicaid
IL036129188Medicaid
FLHH650ZMedicare PIN
FL009268700Medicaid
IL0727500006Medicare NSC