Provider Demographics
NPI:1407927783
Name:DESAI, VIRENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRENDRA
Middle Name:
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 1:7238 N KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1920
Mailing Address - Country:US
Mailing Address - Phone:847-677-4379
Mailing Address - Fax:773-508-1796
Practice Address - Street 1:2649 NORTH LARAMIE AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639
Practice Address - Country:US
Practice Address - Phone:773-745-0391
Practice Address - Fax:773-745-3506
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-044107207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-044107OtherLICENSE
IL036-044107OtherLICENSE