MEDICARE: RAVI KUMAR DESAI MD

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	174400000X	Specialist	213103	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000526060005	OTHER	NY	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	04110332	OTHER	NY	IHA

General Provider Information

NPI Number	:	1407810948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI KUMAR DESAI MD

Provider Business Mailing Address
First Line	:	908 NIAGARA FALLS BLVD
Second Line	:	STE 208
City	:	N TONAWANDA
State	:	NY
Zip	:	14120-2019
Country	:	US
Telephone Number	:	716-692-2160
Fax Number	:	716-692-4342

Provider Business Practice Location Address
First Line	:	17 LIMESTONE DR
Second Line	:	STE 3
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-8600
Country	:	US
Telephone Number	:	716-827-1616
Fax Number	:	716-692-4342

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	04/04/2008

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