MEDICARE: KUSUM DIPAK DESAI MD CHARTERED

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	207RP1001X	Pulmonary Disease Physician	4051	NV

General Provider Information

NPI Number	:	1215161906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUSUM DIPAK DESAI MD CHARTERED

Provider Business Mailing Address
First Line	:	9811 W CHARLESTON BLVD
Second Line	:	STE 2857
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-7528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 MEDICAL CENTER ST
Second Line	:	STE 4
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2405
Country	:	US
Telephone Number	:	702-739-9518
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KUSUM DESAI
Credential	:	MD
Telephone Number	:	702-306-4691

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	02/19/2010

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