Provider Demographics
NPI:1801982228
Name:DESNAK PA
Entity type:Organization
Organization Name:DESNAK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NALINI
Authorized Official - Middle Name:M
Authorized Official - Last Name:NAIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-371-2459
Mailing Address - Street 1:2909 S HAMPTON RD STE F228
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-3056
Mailing Address - Country:US
Mailing Address - Phone:214-371-2459
Mailing Address - Fax:
Practice Address - Street 1:2909 S HAMPTON RD STE F228
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3056
Practice Address - Country:US
Practice Address - Phone:214-371-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175808801Medicaid
TX175808802Medicaid
TX175808801Medicaid
TX00679VMedicare PIN