1306615752 NPI number — DILIP M DESAI

Table of content: (NPI 1306615752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306615752 NPI number — DILIP M DESAI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DILIP M DESAI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306615752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6240 RASHELLE DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-600-2888
Provider Business Mailing Address Fax Number:
810-600-2889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6240 RASHELLE DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-600-2888
Provider Business Practice Location Address Fax Number:
810-600-2889
Provider Enumeration Date:
12/27/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DESAI
Authorized Official First Name:
SANDHYA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
810-600-2888

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1804803 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1002512131 . This is a "BCBSMI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com