Provider Demographics
NPI:1245318120
Name:SUVAS G DESAI MD PSC
Entity type:Organization
Organization Name:SUVAS G DESAI MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUVAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-985-8100
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-0424
Mailing Address - Country:US
Mailing Address - Phone:859-985-8100
Mailing Address - Fax:859-985-8300
Practice Address - Street 1:1011 PAINT LICK RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-9501
Practice Address - Country:US
Practice Address - Phone:859-985-8100
Practice Address - Fax:859-985-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65095440Medicaid
KY7182179OtherAETNA
KY000000045887OtherANTHEM
1800196OtherUNITED HEALTH CARE
1144216318OtherNPI INDIVIDUAL
KY64167232Medicaid
KY64167232Medicaid
KY000000045887OtherANTHEM
KY1669301Medicare ID - Type Unspecified