Provider Demographics
NPI:1477504223
Name:DESAI, ALPANA A (MD)
Entity Type:Individual
Prefix:
First Name:ALPANA
Middle Name:A
Last Name:DESAI
Suffix:
Gender:F
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 102222
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2222
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:301 SE OCEAN BLVD
Practice Address - Street 2:STE 102
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2236
Practice Address - Country:US
Practice Address - Phone:772-287-4061
Practice Address - Fax:772-287-4176
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME78690207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258061600Medicaid
FL47191XMedicare PIN
FL47191YMedicare PIN