Provider Demographics
NPI:1861455172
Name:DESAI, AVINASH M (MD)
Entity Type:Individual
Prefix:
First Name:AVINASH
Middle Name:M
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 HIGHLAND RD
Mailing Address - Street 2:STE 130
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2167
Mailing Address - Country:US
Mailing Address - Phone:248-681-7909
Mailing Address - Fax:248-681-0455
Practice Address - Street 1:4000 HIGHLAND RD
Practice Address - Street 2:STE 130
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2167
Practice Address - Country:US
Practice Address - Phone:248-681-7909
Practice Address - Fax:248-681-5814
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301038163207RS0012X
MI038163207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0631459OtherBS
MI290002630OtherRR MC
MI2574403Medicaid
MI2574403Medicaid
MIOF37790001Medicare ID - Type Unspecified