Provider Demographics
NPI:1265857114
Name:DESAI, JIGNESH (MD)
Entity Type:Individual
Prefix:DR
First Name:JIGNESH
Middle Name:
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 1:1505 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1710
Mailing Address - Country:US
Mailing Address - Phone:502-637-1005
Mailing Address - Fax:
Practice Address - Street 1:1505 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1710
Practice Address - Country:US
Practice Address - Phone:502-637-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-02
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine