Healthcare Provider Details

I. General information

NPI: 1477481679
Provider Name (Legal Business Name): SOHAM DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16815 E JEFFERSON AVE STE 120
GROSSE POINTE MI
48230-1923
US

IV. Provider business mailing address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

V. Phone/Fax

Practice location:
  • Phone: 586-498-4400
  • Fax:
Mailing address:
  • Phone: 313-473-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351056419
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: