Provider Demographics
NPI:1124005038
Name:DESAI, KISHORKUMAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHORKUMAR
Middle Name:A
Last Name:DESAI
Suffix:
Gender:M
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:PO BOX 4300
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-1148
Mailing Address - Country:US
Mailing Address - Phone:270-885-3876
Mailing Address - Fax:270-885-6349
Practice Address - Street 1:1830 HIGH ST STE A
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1746
Practice Address - Country:US
Practice Address - Phone:270-885-3876
Practice Address - Fax:270-885-6349
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38325207RR0500X
KY38463207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64081128Medicaid
TN4091796Medicaid
TN3893698Medicare PIN
KYI08431Medicare UPIN
KY64081128Medicaid
TNP00378575Medicare PIN
TN4091796Medicaid