Provider Demographics
NPI:1295962462
Name:DESAI, AJAY KISHOR (DO)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:KISHOR
Last Name:DESAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1046 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1118
Mailing Address - Country:US
Mailing Address - Phone:863-816-3449
Mailing Address - Fax:
Practice Address - Street 1:1046 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1118
Practice Address - Country:US
Practice Address - Phone:863-816-3449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0147122080P0204X
FLOS125682080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine