Healthcare Provider Details

I. General information

NPI: 1336536648
Provider Name (Legal Business Name): CHITRA DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BELOIT CLINIC 1905 E. HUEBBE PARKWAY
BELOIT WI
53511-1842
US

IV. Provider business mailing address

BELOIT HEALTH SYSTEM INC 1905 E. HUEBBE PARKWAY
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-2220
  • Fax: 608-363-7368
Mailing address:
  • Phone: 608-364-2293
  • Fax: 608-364-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10053052
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number69451-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: