MEDICARE: DR. BIJAL 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
1	207R00000X	Internal Medicine Physician	0101250322	VA
2	207R00000X	Internal Medicine Physician	LL29227	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	29227	OTHER	SC	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0101250322	OTHER	VA	LISENCE

General Provider Information

NPI Number	:	1679593909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BIJAL DESAI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 639856
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9856
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	309 W BUTLER RD
Second Line	:
City	:	MAULDIN
State	:	SC
Zip	:	29662-2531
Country	:	US
Telephone Number	:	864-297-1575
Fax Number	:	877-817-1801

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/21/2023

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