Provider Demographics
NPI:1376516021
Name:DESAI, MUNEER JANAK (MD)
Entity Type:Individual
Prefix:DR
First Name:MUNEER
Middle Name:JANAK
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 1:1320 E DIVISION
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4196
Mailing Address - Country:US
Mailing Address - Phone:360-424-6161
Mailing Address - Fax:360-848-1167
Practice Address - Street 1:1320 E DIVISION
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4196
Practice Address - Country:US
Practice Address - Phone:360-424-6161
Practice Address - Fax:360-848-1167
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000401432085R0202X
MN756262085R0202X
GUMC-1912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8354425Medicaid
WA171217OtherL & I
WA171217OtherL & I
WA8354425Medicaid