Provider Demographics
NPI:1346231750
Name:DESAI, PRAKASH K (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:K
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 1:1901 PORT LN
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2430
Mailing Address - Country:US
Mailing Address - Phone:806-358-4596
Mailing Address - Fax:806-468-0240
Practice Address - Street 1:1901 PORT LN
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1736
Practice Address - Country:US
Practice Address - Phone:806-358-4596
Practice Address - Fax:806-468-0240
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6918207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E57238Medicare UPIN
8C8876Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER