Provider Demographics
NPI:1740801026
Name:DESAI, KUSH (DPM)
Entity Type:Individual
Prefix:
First Name:KUSH
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 FRANCE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2808
Mailing Address - Country:US
Mailing Address - Phone:860-796-9601
Mailing Address - Fax:
Practice Address - Street 1:999 ASYLUM AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2416
Practice Address - Country:US
Practice Address - Phone:860-523-8026
Practice Address - Fax:860-523-7622
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1155213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery