Provider Demographics
NPI:1740271527
Name:DESAI, TUSAR K (MD)
Entity type:Individual
Prefix:DR
First Name:TUSAR
Middle Name:K
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1701 SOUTH BLVD E STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6120
Mailing Address - Country:US
Mailing Address - Phone:248-884-9710
Mailing Address - Fax:248-884-9711
Practice Address - Street 1:4600 INVESTMENT DR STE 270
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6375
Practice Address - Country:US
Practice Address - Phone:248-884-9710
Practice Address - Fax:248-884-9711
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044285207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2836211Medicaid
OF371439101Medicare ID - Type Unspecified
MI2836211Medicaid