Provider Demographics
NPI:1144216318
Name:DESAI, SUVAS GHELABHAI (MD)
Entity Type:Individual
Prefix:
First Name:SUVAS
Middle Name:GHELABHAI
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 1:56 MARIE LANGDON DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-6329
Mailing Address - Country:US
Mailing Address - Phone:606-598-5104
Mailing Address - Fax:606-598-0983
Practice Address - Street 1:56 MARIE LANGDON DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-6329
Practice Address - Country:US
Practice Address - Phone:606-598-5104
Practice Address - Fax:606-598-1688
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
KY16723208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000045887OtherANTHEM
KY64167232Medicaid
KYC73821Medicare UPIN
KY000000045887OtherANTHEM
KY1669301Medicare ID - Type Unspecified