Provider Demographics
NPI:1013020593
Name:DESAI, KALPANA PANKAJ (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:PANKAJ
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 HIGHWAY 466
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6340
Mailing Address - Country:US
Mailing Address - Phone:321-274-1864
Mailing Address - Fax:352-259-1132
Practice Address - Street 1:773 HIGHWAY 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6340
Practice Address - Country:US
Practice Address - Phone:352-259-6949
Practice Address - Fax:352-259-1132
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208831-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00139766Medicare ID - Type UnspecifiedMEDICARE RAILROAD #
NYI08088Medicare UPIN
NYRA2117Medicare ID - Type UnspecifiedMEDICARE # IN PROF GROUP