Provider Demographics
NPI:1033152194
Name:DESAI, PANKAJ
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-2110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-934-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17669207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010033CE94314OtherSECTION 1011
ALE94314OtherVIVA
AL000084210Medicaid
AL2866OtherHEALTHSPRING OF ALABAMA
MS00110026OtherMISSISSIPPI MEDICAID
AL050086713OtherRAILROAD MEDICARE
AL051511512OtherBLUE CROSS
AL000084210OtherBLUE CROSS
AL051511513OtherBLUE CROSS
AL000084210Medicaid