Provider Demographics
NPI:1346356920
Name:DESAI, RAJENDRA SHANTILAL (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:SHANTILAL
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3175
Mailing Address - Fax:812-242-3543
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3175
Practice Address - Fax:812-242-3543
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035315A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00844272OtherRAILROAD MEDICARE
4062046OtherAETNA ASSIGNED
I018482D005OtherUNISYS CHAMPUS SECONDARY
IN100251700Medicaid
IN100251700AOtherMOLINA HEALTHCARE MCAID
351904269123OtherCARESOURCE MEDICAID
000000089586OtherANTHEM
IN110044260OtherRAILROAD MEDICARE
166830OtherHEALTHLINK
060004992OtherRAILROAD MCARE PALAMETTO
0182868OtherUS DEPT OF LABOR
0182868OtherUS DEPT OF LABOR
166830OtherHEALTHLINK
4062046OtherAETNA ASSIGNED
IN110044260OtherRAILROAD MEDICARE
IN100251700Medicaid
060004992OtherRAILROAD MCARE PALAMETTO