Provider Demographics
NPI:1417111584
Name:DESAI AJMERE, RESHMA (MD)
Entity Type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:DESAI AJMERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RESHMA
Other - Middle Name:D
Other - Last Name:AJMERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7530 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3100
Mailing Address - Country:US
Mailing Address - Phone:630-910-1177
Mailing Address - Fax:630-396-3487
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-1177
Practice Address - Fax:630-396-3487
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-121186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121186Medicaid
IL363468127OtherTAX ID NUMBER
IL04515143OtherBCBS#
IL036121186Medicaid
IL390362036Medicare PIN
IL390361041Medicare PIN