Provider Demographics
NPI:1821054172
Name:DESAI, MEENAKSHI M (MD FACS)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:M
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD FACS
Other - Prefix:
Other - First Name:MEENAKSHI
Other - Middle Name:M
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD FACS
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2340
Mailing Address - Country:US
Mailing Address - Phone:618-244-3200
Mailing Address - Fax:618-244-3254
Practice Address - Street 1:3000 BROADWAY
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-0020
Practice Address - Country:US
Practice Address - Phone:618-244-3200
Practice Address - Fax:618-244-3254
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053115207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL109262OtherHEALTHLINK
IL036053115Medicaid
IL4100079OtherBLUE CROSS BLUE SHIELD
IL036053115Medicaid
D14080Medicare UPIN