Healthcare Provider Details

I. General information

NPI: 1649137837
Provider Name (Legal Business Name): ANJALI DESAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 1050
CHICAGO IL
60611-3054
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 1050
CHICAGO IL
60611-3054
US

V. Phone/Fax

Practice location:
  • Phone: 312-642-5515
  • Fax:
Mailing address:
  • Phone: 312-642-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041519876
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: