Healthcare Provider Details

I. General information

NPI: 1780806687
Provider Name (Legal Business Name): THERESA ANN DESAI CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA ANN WINDRAM CDE

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W RAND RD # 110
ARLINGTON HEIGHTS IL
60004-2315
US

IV. Provider business mailing address

1051 W RAND RD # 110
ARLINGTON HEIGHTS IL
60004-2315
US

V. Phone/Fax

Practice location:
  • Phone: 847-618-9292
  • Fax: 847-618-9294
Mailing address:
  • Phone: 847-618-9292
  • Fax: 847-618-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164-003294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: