Provider Demographics
NPI:1871584946
Name:PATEL, GAURANG P (MD)
Entity type:Individual
Prefix:DR
First Name:GAURANG
Middle Name:P
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2857
Mailing Address - Fax:217-876-2874
Practice Address - Street 1:2300 N EDWARD ST
Practice Address - Street 2:SUITE 3200
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4163
Practice Address - Country:US
Practice Address - Phone:217-876-3660
Practice Address - Fax:217-876-3665
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2014-10-15
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Provider Licenses
StateLicense IDTaxonomies
IL036075836207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036075836Medicaid
ILE21752Medicare UPIN
IL909490Medicare ID - Type Unspecified