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NPI Code Detail

MEDICARE: SURESHCHANDRA N. DESAI M.D.

MEDICARE: SURESHCHANDRA N. DESAI M.D.
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
12084P0800XPsychiatry PhysicianME29225FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518051325
Entity Type Code : Individual
Provider Name (Legal Business Name) : SURESHCHANDRA N. DESAI M.D.
Provider Business Mailing Address
First Line : 7956 PLANTATION LAKES DR
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34986-3011
Country : US
Telephone Number : 772-489-5852
Fax Number :
Provider Business Practice Location Address
First Line : 4500 W MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-4823
Country : US
Telephone Number : 772-468-5600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 07/08/2007

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