Provider Demographics
NPI:1982479598
Name:DILIP M DESAI
Entity Type:Organization
Organization Name:DILIP M DESAI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-600-2888
Mailing Address - Street 1:6240 RASHELLE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-600-2888
Mailing Address - Fax:810-600-2889
Practice Address - Street 1:6240 RASHELLE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-600-2888
Practice Address - Fax:810-600-2889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1002512131OtherBLUECROSS/BLUESHIELD MI
MI1804803Medicaid