Provider Demographics
NPI:1457398588
Name:DESAI, AJITKUMAR M (MD)
Entity Type:Individual
Prefix:
First Name:AJITKUMAR
Middle Name:M
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 1:27 ST LAWRENCE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-8314
Mailing Address - Country:US
Mailing Address - Phone:419-455-8570
Mailing Address - Fax:419-455-8579
Practice Address - Street 1:27 ST LAWRENCE DR STE 203
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-8314
Practice Address - Country:US
Practice Address - Phone:419-455-8570
Practice Address - Fax:419-455-8579
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039068D174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0405690Medicaid
OHA75622Medicare PIN