Provider Demographics
NPI:1881831576
Name:DESAI MEDICAL CENTER FOR PRIMARY CARE AND INTEGRATIVE MEDICINE PA
Entity Type:Organization
Organization Name:DESAI MEDICAL CENTER FOR PRIMARY CARE AND INTEGRATIVE MEDICINE PA
Other - Org Name:INTEGRATED FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALPANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-274-1864
Mailing Address - Street 1:773 CR 466
Mailing Address - Street 2:THE SUMMIT OF LADY LAKE
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6340
Mailing Address - Country:US
Mailing Address - Phone:321-274-1864
Mailing Address - Fax:352-259-1132
Practice Address - Street 1:773 COUNTY ROAD 466
Practice Address - Street 2:THE SUMMIT OF LADY LAKE
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6340
Practice Address - Country:US
Practice Address - Phone:321-274-1864
Practice Address - Fax:352-259-1132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92848261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280106000Medicaid
FL280106000Medicaid
FLI08088Medicare UPIN