Healthcare Provider Details

I. General information

NPI: 1215066345
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: 03/05/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 W 35TH ST
CICERO IL
60804-4163
US

IV. Provider business mailing address

5909 W 35TH ST
CICERO IL
60804-4163
US

V. Phone/Fax

Practice location:
  • Phone: 708-652-2040
  • Fax: 708-652-0058
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 Number
License Number StateIL

VIII. Authorized Official

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