Provider Demographics
NPI:1841234655
Name:DESAI, EMMANUEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:F
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:125 N COWAN STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3737
Mailing Address - Country:US
Mailing Address - Phone:972-221-0600
Mailing Address - Fax:972-221-8265
Practice Address - Street 1:125 N COWAN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3737
Practice Address - Country:US
Practice Address - Phone:972-221-0600
Practice Address - Fax:972-221-8265
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE9603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145407601Medicaid
TX82Z951Medicare PIN
TXC15199Medicare UPIN