MEDICARE: DIPTI VANRAJ DESAI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA06520	TX

General Provider Information

NPI Number	:	1104149574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIPTI VANRAJ DESAI PA-C

Provider Business Mailing Address
First Line	:	13333 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1144
Country	:	US
Telephone Number	:	972-636-5727
Fax Number	:	972-499-2540

Provider Business Practice Location Address
First Line	:	13333 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-1144
Country	:	US
Telephone Number	:	972-636-5727
Fax Number	:	972-499-2540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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