Healthcare Provider Details

I. General information

NPI: 1871886721
Provider Name (Legal Business Name): BHAVIM DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 BALCONES DR STE 303
AUSTIN TX
78731-4286
US

IV. Provider business mailing address

5929 BALCONES DR STE 303
AUSTIN TX
78731-4286
US

V. Phone/Fax

Practice location:
  • Phone: 512-697-9896
  • Fax:
Mailing address:
  • Phone: 512-697-9896
  • Fax: 509-942-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301099113
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberC162368
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60693801
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberR8174
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: