Healthcare Provider Details

I. General information

NPI: 1346553450
Provider Name (Legal Business Name): ANKIT DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2010
Last Update Date: 01/18/2020
Certification Date: 01/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15905 S FREDERICK ST STE 105
PLAINFIELD IL
60586-2212
US

IV. Provider business mailing address

15905 S FREDERICK ST STE 105
PLAINFIELD IL
60586-2212
US

V. Phone/Fax

Practice location:
  • Phone: 815-714-9115
  • Fax:
Mailing address:
  • Phone: 815-714-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125057904
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036.139926
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number036.139926
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: