Provider Demographics
NPI:1720050925
Name:DESAI, PRASHANT J (DO)
Entity Type:Individual
Prefix:
First Name:PRASHANT
Middle Name:J
Last Name:DESAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7830
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:2300 E COUNTY ROAD 540A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3825
Practice Address - Country:US
Practice Address - Phone:863-680-7214
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9090207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272744700Medicaid
FL272744700Medicaid
FL48302YMedicare PIN
I19794Medicare UPIN