Provider Demographics
NPI:1952417644
Name:DESAI, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7255 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-3043
Mailing Address - Country:US
Mailing Address - Phone:913-631-0405
Mailing Address - Fax:913-631-0409
Practice Address - Street 1:7255 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-3043
Practice Address - Country:US
Practice Address - Phone:913-631-0405
Practice Address - Fax:913-631-0409
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04249382207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100158200CMedicaid
KS100158200CMedicaid
KSH950203Medicare ID - Type Unspecified