Provider Demographics
NPI:1205082443
Name:I.DESAI & R. GOKANI, M.D.,S.C.
Entity type:Organization
Organization Name:I.DESAI & R. GOKANI, M.D.,S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-652-2040
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 1:235 REMINGTON BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5826
Practice Address - Country:US
Practice Address - Phone:630-771-1201
Practice Address - Fax:630-771-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213405Medicare PIN