Healthcare Provider Details

I. General information

NPI: 1295269397
Provider Name (Legal Business Name): ANAND R DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE B202
MCHENRY IL
60050-8417
US

IV. Provider business mailing address

4309 W MEDICAL CENTER DR STE B202
MCHENRY IL
60050-8417
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-2752
  • Fax: 815-455-2789
Mailing address:
  • Phone: 815-455-2752
  • Fax: 815-455-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA11379700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036169141
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.169141
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: