Provider Demographics
NPI:1366026171
Name:DESAI, ADITYA MUKESH (MD)
Entity Type:Individual
Prefix:
First Name:ADITYA
Middle Name:MUKESH
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 1:08 ATMAN APARTMENT RAVISHANKAR SANKUL,BHATAR CHAR RASTA
Mailing Address - Street 2:
Mailing Address - City:SURAT
Mailing Address - State:GUJARAT
Mailing Address - Zip Code:395017
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404
Practice Address - Country:US
Practice Address - Phone:909-883-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program