Healthcare Provider Details

I. General information

NPI: 1598738759
Provider Name (Legal Business Name): RAJIV DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N FOOTE AVE
COLORADO SPRINGS CO
80909-4554
US

IV. Provider business mailing address

525 N FOOTE AVE
COLORADO SPRINGS CO
80909-4561
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-8111
  • Fax: 719-630-1620
Mailing address:
  • Phone: 719-630-8111
  • Fax: 719-630-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number40929
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: