MEDICARE: DR. CHETAN K DESAI MD

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
1	207RG0100X	Gastroenterology Physician	ME59176	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	100013672	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	211863	OTHER	AV MED
2	231448	OTHER	AMERIGROUP
3	2905012	OTHER	UNITED HEALTHCARE
4	SN13000	OTHER	CAREPLUS
6	10694901	OTHER	CITRUS HEALTHCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	01532	OTHER	WELLCARE
9	14960	OTHER	BCBS
10	2452114-018	OTHER	CIGNA
11	2510731	OTHER	GHI
12	4349248	OTHER	AETNA
13	852	OTHER	UNIVERSAL HEALTHCARE

General Provider Information

NPI Number	:	1982675526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHETAN K DESAI MD

Provider Business Mailing Address
First Line	:	3001 EXECUTIVE DR STE 130
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33762-5323
Country	:	US
Telephone Number	:	727-347-0005
Fax Number	:	727-541-6558

Provider Business Practice Location Address
First Line	:	3901 66TH ST N
Second Line	:	SUITE 201
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-4911
Country	:	US
Telephone Number	:	727-345-5500
Fax Number	:	727-345-6164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	09/28/2021

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