Healthcare Provider Details

I. General information

NPI: 1619505898
Provider Name (Legal Business Name): KEVIN VIPUL DESAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W PARK DR
GRAND JUNCTION CO
81505-1618
US

IV. Provider business mailing address

UIC INTERNAL MEDICINE RESIDENCY 840 S. WOOD STREET RM 427 (MC 178)
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 303-272-0644
  • Fax:
Mailing address:
  • Phone: 866-600-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDR.0077271
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: