Healthcare Provider Details

I. General information

NPI: 1861455172
Provider Name (Legal Business Name): AVINASH M DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HIGHLAND RD STE 130
WATERFORD MI
48328-2167
US

IV. Provider business mailing address

4000 HIGHLAND RD STE 130
WATERFORD MI
48328-2167
US

V. Phone/Fax

Practice location:
  • Phone: 248-681-7909
  • Fax: 248-681-5814
Mailing address:
  • Phone: 248-681-7909
  • Fax: 248-681-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number4301038163
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number038163
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: