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General NPI Number Information
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NPI Number | 1174075857
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Entity Type | Organization
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Legal Business Name | ID PARTNERS PA
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 350 MATLOCK RD STE 201
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 817-539-9091
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Fax | 817-539-9553
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Provider Business Mailing Address
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Address Line | 350 MATLOCK RD STE 201
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 817-539-9091
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Fax | 817-539-9553
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEVAK DESAI
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Credential | MD
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Telephone | 817-539-9091
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | N1611
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License Number State | TX
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