Provider Demographics
NPI:1235131947
Name:DESAI, AMARJIT M (MD)
Entity Type:Individual
Prefix:DR
First Name:AMARJIT
Middle Name:M
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1324 WOODLAND DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2651
Mailing Address - Country:US
Mailing Address - Phone:270-765-5921
Mailing Address - Fax:270-765-4391
Practice Address - Street 1:1324 WOODLAND DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2651
Practice Address - Country:US
Practice Address - Phone:270-765-5921
Practice Address - Fax:270-765-4391
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18969174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64189699Medicaid
KY64189699Medicaid
KY0200202Medicare PIN
KYK200060Medicare PIN