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General NPI Number Information
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NPI Number | 1295962462
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Entity Type | Individual
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Provider Name | AJAY KISHOR DESAI D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 1046 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33803-1118
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Country | US
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Telephone | 863-816-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 1046 S FLORIDA AVE
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City | LAKELAND
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State | FL
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Zip | 33803-1118
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Country | US
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Telephone | 863-816-3449
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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 | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | OS014712
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | OS12568
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License Number State | FL
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