Healthcare Provider Details

I. General information

NPI: 1235572173
Provider Name (Legal Business Name): RIA DIRGHAYU DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1520
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

555 W KINZIE ST APT 2406
CHICAGO IL
60654-5855
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8150
  • Fax:
Mailing address:
  • Phone: 757-620-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036.142549
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: