Healthcare Provider Details

I. General information

NPI: 1508090234
Provider Name (Legal Business Name): CHAITANYA RAJENDRA DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2009
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 NE GLEN OAK AVE STE 401
PEORIA IL
61603
US

IV. Provider business mailing address

420 NE GLEN OAK AVE STE 401
PEORIA IL
61603
US

V. Phone/Fax

Practice location:
  • Phone: 309-676-8123
  • Fax: 309-676-8455
Mailing address:
  • Phone: 309-676-8123
  • Fax: 309-676-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.131408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: