Provider Demographics
NPI:1710975255
Name:DESAI, RUCHIK S (MD)
Entity Type:Individual
Prefix:DR
First Name:RUCHIK
Middle Name:S
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3190 LANCER ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4408
Mailing Address - Country:US
Mailing Address - Phone:219-764-3600
Mailing Address - Fax:219-764-3661
Practice Address - Street 1:3190 LANCER ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4408
Practice Address - Country:US
Practice Address - Phone:219-764-3600
Practice Address - Fax:219-764-3661
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057862A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000350979OtherANTHEM
IN220770Medicare ID - Type Unspecified
IN000000350979OtherANTHEM