Provider Demographics
NPI:1770937500
Name:DESAI, PATHIK J (MD)
Entity type:Individual
Prefix:DR
First Name:PATHIK
Middle Name:J
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5616 LAWNDALE ST STE 108&A110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-3821
Mailing Address - Country:US
Mailing Address - Phone:832-548-5000
Mailing Address - Fax:
Practice Address - Street 1:1001 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-7254
Practice Address - Country:US
Practice Address - Phone:314-543-5970
Practice Address - Fax:314-822-2105
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019046134207Q00000X
TXS6603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine