Healthcare Provider Details

I. General information

NPI: 1407417454
Provider Name (Legal Business Name): JINAL DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALTRU HEALTH SYSTEM 1200 SOUTH COLUMBIA ROAD
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax: 701-780-4477
Mailing address:
  • Phone: 701-780-1891
  • Fax: 701-293-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number18915
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: