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NPI Code Detail

MEDICARE: DR. ISHVER H DESAI M.D.

MEDICARE: DR. ISHVER H DESAI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician3649479IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2111910675OTHERILRAIL ROAD MEDICARE PIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3277330OTHERILWELLCARE HMO
4640OTHERILCHICAGO HEALTH SYSTEMS (CHS)
5003649479OTHERILBLUE SHIELD, IL
63649479OTHERSTATE LICENSE

General Provider Information

NPI Number : 1972691962
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ISHVER H DESAI M.D.
Provider Business Mailing Address
First Line : 5909 W 35TH ST
Second Line :
City : CICERO
State : IL
Zip : 60804-4163
Country : US
Telephone Number : 708-652-2040
Fax Number : 708-652-0058
Provider Business Practice Location Address
First Line : 5909 W 35TH ST
Second Line :
City : CICERO
State : IL
Zip : 60804-4163
Country : US
Telephone Number : 708-652-2040
Fax Number : 708-652-0058
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 07/05/2012

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Directions to “ DR. ISHVER H DESAI M.D.” Practice Location

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