Provider Demographics
NPI:1811959711
Name:DESAI, HEMANGINI A (MD)
Entity type:Individual
Prefix:
First Name:HEMANGINI
Middle Name:A
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4000 HIGHLAND RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2168
Mailing Address - Country:US
Mailing Address - Phone:248-681-7909
Mailing Address - Fax:248-681-0455
Practice Address - Street 1:4000 HIGHLAND RD
Practice Address - Street 2:SUITE 130
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2168
Practice Address - Country:US
Practice Address - Phone:248-681-7909
Practice Address - Fax:248-681-0455
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI046638207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1195323242OtherBS
MI110028062OtherRR MC
MI1961897Medicaid
MI1961897Medicaid
A76707Medicare UPIN