MEDICARE: JAGDISH DESAI

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	183500000X	Pharmacist	051-033681	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1992252944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGDISH DESAI

Provider Business Mailing Address
First Line	:	1608 W 69TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3316
Country	:	US
Telephone Number	:	773-778-3420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 W 69TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-3316
Country	:	US
Telephone Number	:	773-778-3420
Fax Number	:

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

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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Directions to “ JAGDISH DESAI ” Practice Location

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