Healthcare Provider Details

I. General information

NPI: 1063556991
Provider Name (Legal Business Name): BELA D DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 RAND RD
DES PLAINES IL
60016-1005
US

IV. Provider business mailing address

P.O. BOX 1935
DES PLAINES IL
60017-1935
US

V. Phone/Fax

Practice location:
  • Phone: 847-803-1344
  • Fax: 847-803-3791
Mailing address:
  • Phone: 847-803-1344
  • Fax: 847-803-3791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036100458
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036100458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: