Healthcare Provider Details

I. General information

NPI: 1609865294
Provider Name (Legal Business Name): MEGHNA RAMESH DESAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W CARPENTER ST FL 1
SPRINGFIELD IL
62702-4901
US

IV. Provider business mailing address

PO BOX 19678
SPRINGFIELD IL
62794-9678
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-1141
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036-126205
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: