Healthcare Provider Details

I. General information

NPI: 1265857114
Provider Name (Legal Business Name): JIGNESH DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2014
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 S 7TH ST
LOUISVILLE KY
40208-1710
US

IV. Provider business mailing address

1505 S 7TH ST
LOUISVILLE KY
40208-1710
US

V. Phone/Fax

Practice location:
  • Phone: 502-637-1005
  • Fax:
Mailing address:
  • Phone: 502-637-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47406
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: