Healthcare Provider Details

I. General information

NPI: 1669412599
Provider Name (Legal Business Name): BIPIN PRATACHANDRA DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 KISSANE ST
BRIGHTON MI
48116
US

IV. Provider business mailing address

136 KISSANE ST
BRIGHTON MI
48116
US

V. Phone/Fax

Practice location:
  • Phone: 810-229-7337
  • Fax: 810-229-6601
Mailing address:
  • Phone: 810-229-7337
  • Fax: 810-229-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301040129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: