Provider Demographics
NPI:1659649663
Name:DESAI, MINAL PRASHANT (MD)
Entity Type:Individual
Prefix:
First Name:MINAL PRASHANT
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MINAL RAJARAM
Other - Middle Name:
Other - Last Name:PATIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:349 LUKE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8720
Mailing Address - Country:US
Mailing Address - Phone:224-656-3838
Mailing Address - Fax:
Practice Address - Street 1:162 LEGACY OAKS DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6556
Practice Address - Country:US
Practice Address - Phone:919-373-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.019698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine