Provider Demographics
NPI:1497741037
Name:DESAI, SANDIP R (MD)
Entity Type:Individual
Prefix:
First Name:SANDIP
Middle Name:R
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 1:7015 ALMEDA RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2101
Mailing Address - Country:US
Mailing Address - Phone:832-255-6632
Mailing Address - Fax:
Practice Address - Street 1:16959 SOUTHWEST FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3481
Practice Address - Country:US
Practice Address - Phone:832-255-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TXM1073207RP1001X, 207RC0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178112201Medicaid
TX8DE525OtherBCBS
TXPO1238234OtherRAILROAD MEDICARE
TX8DE525OtherBCBS
TX8D7397Medicare UPIN
TXTXB148576Medicare PIN
TX8D7397Medicare PIN
TXTXB153855Medicare PIN
TXH33944Medicare UPIN