Healthcare Provider Details

I. General information

NPI: 1205082443
Provider Name (Legal Business Name): I.DESAI & R. GOKANI, M.D.,S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 REMINGTON BLVD SUITE E
BOLINGBROOK IL
60440-5826
US

IV. Provider business mailing address

5909 W 35TH ST
CICERO IL
60804-4163
US

V. Phone/Fax

Practice location:
  • Phone: 630-771-1201
  • Fax: 630-771-1203
Mailing address:
  • Phone: 708-652-2040
  • Fax: 708-652-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036098420
License Number StateIL

VIII. Authorized Official

Name: MISS ERIN MCCLEMENT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 708-652-2040