Provider Demographics
NPI:1508090234
Name:DESAI, CHAITANYA RAJENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAITANYA
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 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:773-654-2720
Mailing Address - Fax:312-654-0118
Practice Address - Street 1:825 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-1511
Practice Address - Country:US
Practice Address - Phone:773-890-4330
Practice Address - Fax:773-890-4540
Is Sole Proprietor?:No
Enumeration Date:2009-05-09
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131408207R00000X
IN01089812A207RN0300X
WV31497207RN0300X
IL036.131408207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid