Provider Demographics
NPI:1265676290
Name:DESA, HANDEL G (MD)
Entity Type:Individual
Prefix:
First Name:HANDEL
Middle Name:G
Last Name:DESA
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 1:6005 MONCLOVA RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1864
Mailing Address - Country:US
Mailing Address - Phone:419-383-5502
Mailing Address - Fax:
Practice Address - Street 1:6005 MONCLOVA RD
Practice Address - Street 2:SUITE # 220
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1864
Practice Address - Country:US
Practice Address - Phone:419-383-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-099782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine