Provider Demographics
NPI:1871601989
Name:PATIL, ROHIDAS T (MD)
Entity type:Individual
Prefix:
First Name:ROHIDAS
Middle Name:T
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1770 E LAKESHORE DR
Mailing Address - Street 2:STE 209
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3823
Mailing Address - Country:US
Mailing Address - Phone:217-423-6500
Mailing Address - Fax:217-423-6536
Practice Address - Street 1:1770 E LAKESHORE DR
Practice Address - Street 2:STE 209
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3823
Practice Address - Country:US
Practice Address - Phone:217-423-6500
Practice Address - Fax:217-423-6536
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2009-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360528812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052881Medicaid
ILK13311Medicare ID - Type Unspecified
D09964Medicare UPIN