Provider Demographics
NPI:1972691962
Name:DESAI, ISHVER H (MD)
Entity Type:Individual
Prefix:DR
First Name:ISHVER
Middle Name:H
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ISHVER
Other - Middle Name:
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5909 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4163
Mailing Address - Country:US
Mailing Address - Phone:708-652-2040
Mailing Address - Fax:708-652-0058
Practice Address - Street 1:5909 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4163
Practice Address - Country:US
Practice Address - Phone:708-652-2040
Practice Address - Fax:708-652-0058
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3649479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049479Medicaid
IL111910675OtherRAIL ROAD MEDICARE PIN
IL277330OtherWELLCARE HMO
IL640OtherCHICAGO HEALTH SYSTEMS (CHS)
IL003649479OtherBLUE SHIELD, IL
3649479OtherSTATE LICENSE
IL111910675OtherRAIL ROAD MEDICARE PIN
IL003649479OtherBLUE SHIELD, IL
ILD12780Medicare UPIN