Provider Demographics
NPI:1326263328
Name:EMMANUEL F.DESAI.M.D.,P.A.
Entity Type:Organization
Organization Name:EMMANUEL F.DESAI.M.D.,P.A.
Other - Org Name:LEWISVILLE DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-221-0600
Mailing Address - Street 1:125 N COWAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3737
Mailing Address - Country:US
Mailing Address - Phone:972-221-0600
Mailing Address - Fax:972-221-8265
Practice Address - Street 1:125 N COWAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3737
Practice Address - Country:US
Practice Address - Phone:972-221-0600
Practice Address - Fax:972-221-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145407601Medicaid
TX00U22QMedicare PIN
TXC15199Medicare UPIN