Provider Demographics
NPI:1508809757
Name:DESAI, ANIL I (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:I
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 631148
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0013
Mailing Address - Country:US
Mailing Address - Phone:972-385-9898
Mailing Address - Fax:888-770-6360
Practice Address - Street 1:8501 N MACARTHUR BLVD # 1148
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4100
Practice Address - Country:US
Practice Address - Phone:972-385-9898
Practice Address - Fax:888-770-6360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL4906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00061214OtherMEDICARE RAILROAD
TXL4906OtherSTATE LICENSES
TX8K5410OtherBCBS
TX152223702Medicaid
TXL4906OtherSTATE LICENSES
TX8B1521Medicare PIN