Provider Demographics
NPI:1861488454
Name:DESAI, PRATIBHA KIRIT (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIBHA
Middle Name:KIRIT
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5000 PARK ST N
Mailing Address - Street 2:STE 1017
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2236
Mailing Address - Country:US
Mailing Address - Phone:727-344-6570
Mailing Address - Fax:727-384-4388
Practice Address - Street 1:5000 PARK ST N STE 1017
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2236
Practice Address - Country:US
Practice Address - Phone:727-344-6569
Practice Address - Fax:727-384-4388
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME66436174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378208500Medicaid
FL26693OtherBCBS FL
FLP02205624OtherRAILROAD MEDICARE