| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JOSHA PATEL | 1518555028 | 2021-01-10 |
| Entity Type | Individual |
| Provider Name | Josha Patel |
| Practice Office Address | 6655 GRAND AVE GURNEE, IL US |
| Practice Office Telephone | 8478568701 |
| Practice Office Fax | 8478568704 |
| Mailing Address | 6655 GRAND AVE GURNEE, IL 600314591 US |
| Code | License No | State |
|---|---|---|
| 1835P0018X PRIMARY | 051303539 | IL |