Provider Demographics
NPI:1407822422
Name:DESAI, MIT NAVANIT (MD)
Entity Type:Individual
Prefix:DR
First Name:MIT
Middle Name:NAVANIT
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:PO BOX 21647
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1647
Mailing Address - Country:US
Mailing Address - Phone:813-530-5043
Mailing Address - Fax:813-530-5043
Practice Address - Street 1:17222 HOSPITAL BLVD STE 116
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-8925
Practice Address - Country:US
Practice Address - Phone:813-751-0427
Practice Address - Fax:813-948-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 87408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267583800Medicaid
FL7144ZMedicare UPIN
71444Medicare ID - Type Unspecified