Provider Demographics
NPI:1396966743
Name:DESAI, RIKESH RAJENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:RIKESH
Middle Name:RAJENDRA
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13921 W GRAND AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2439
Mailing Address - Country:US
Mailing Address - Phone:623-214-2200
Mailing Address - Fax:623-214-2208
Practice Address - Street 1:13921 W GRAND AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2439
Practice Address - Country:US
Practice Address - Phone:623-214-2200
Practice Address - Fax:623-214-2208
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36199207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ363867Medicaid
AZZ153509Medicare PIN