Healthcare Provider Details

I. General information

NPI: 1467828343
Provider Name (Legal Business Name): BIPIN DESAI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 KISSANE AVE
BRIGHTON MI
48116-2467
US

IV. Provider business mailing address

136 KISSANE AVE
BRIGHTON MI
48116-2467
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 TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BIPIN DESAI
Title or Position: CHIEF PEDIATRICIAN
Credential: M.D.
Phone: 810-229-7337