Healthcare Provider Details

I. General information

NPI: 1194906560
Provider Name (Legal Business Name): KUSH RAJESH DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST SUITE 800
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 800
CHICAGO IL
60611-2978
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-4068
  • Fax:
Mailing address:
  • Phone: 312-695-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036.129986
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: