Provider Demographics
NPI:1851407290
Name:DESAI, HEMANT R (MD)
Entity Type:Individual
Prefix:
First Name:HEMANT
Middle Name:R
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7047 66TH ST
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4002
Mailing Address - Country:US
Mailing Address - Phone:727-545-8887
Mailing Address - Fax:727-544-5959
Practice Address - Street 1:7047 66TH ST
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4002
Practice Address - Country:US
Practice Address - Phone:727-545-8887
Practice Address - Fax:727-544-5959
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCC1712OtherRAILROAD MEDICARE GROUP
FL33974BMedicare PIN
FLCC1712OtherRAILROAD MEDICARE GROUP
FL33974AMedicare PIN
FL33974Medicare ID - Type Unspecified
FL33974CMedicare PIN