Healthcare Provider Details

I. General information

NPI: 1861515843
Provider Name (Legal Business Name): MANISH ANILKUMAR DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW H K DODGEN LOOP
TEMPLE TX
76502-1814
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-5437
  • Fax: 254-935-4111
Mailing address:
  • Phone: 254-724-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberM9253
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: