Healthcare Provider Details

I. General information

NPI: 1215202429
Provider Name (Legal Business Name): AMISH HARISH DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HARVESTER DR SUITE 110
BURR RIDGE IL
60527-7594
US

IV. Provider business mailing address

636 RAYMOND DR STE 306
NAPERVILLE IL
60563-9792
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1150
  • Fax:
Mailing address:
  • Phone: 331-732-4500
  • Fax: 331-732-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036137953
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036137953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: