| Innovative Geriatrics Llc | |
|
301 Madison St Ste 310 Joliet IL 60435-6686 | |
| (815) 773-7737 | |
| Not Available |
| Full Name | Innovative Geriatrics Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 301 Madison St Ste 310, Joliet, Illinois |
| Authorized Official Name and Position | Yaquta Patni (CEO) |
| Authorized Official Contact | 2064372948 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Geriatrics Llc 3040 Bella Ct Lisle IL 60532-1696 Ph: (206) 437-2948 | Innovative Geriatrics Llc 301 Madison St Ste 310 Joliet IL 60435-6686 Ph: (815) 773-7737 |
| NPI Number | 1578078754 |
|---|---|
| Provider Enumeration Date | 12/09/2017 |
| Last Update Date | 03/07/2022 |
| Medicare PECOS PAC ID | 9234499716 |
|---|---|
| Medicare Enrollment ID | O20180131002399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578078754 | NPI | - | NPPES |
| 036106333 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | 036106333 (Illinois) | Primary |
| Provider Name | Yaquta Mustafa Patni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689779357 PECOS PAC ID: 5193758969 Enrollment ID: I20130813000304 |
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