Provider Demographics
NPI:1669412599
Name:DESAI, BIPIN PRATACHANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:BIPIN
Middle Name:PRATACHANDRA
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 1:136 KISSANE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116
Mailing Address - Country:US
Mailing Address - Phone:810-229-7337
Mailing Address - Fax:810-229-6601
Practice Address - Street 1:136 KISSANE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116
Practice Address - Country:US
Practice Address - Phone:810-229-7337
Practice Address - Fax:810-229-6601
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2106591Medicaid
D90133Medicare UPIN