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General NPI Number Information
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NPI Number | 1164318432
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Entity Type | Individual
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Provider Name | VISHWA DESAI
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Gender | Female
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Dates
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Enumeration Date | 06/14/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 34344 N US HIGHWAY
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City | THIRD LAKE
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State | IL
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Zip | 60030-4031
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Country | US
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Telephone | 866-389-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 34344 N US HIGHWAY
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City | THIRD LAKE
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State | IL
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Zip | 60030-4031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.032259
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041424380
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License Number State | IL
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