1871514638 NPI number — DR. NEERAJ R. DESAI MD

Table of content: DR. NEERAJ R. DESAI MD (NPI 1871514638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871514638 NPI number — DR. NEERAJ R. DESAI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DESAI
Provider First Name:
NEERAJ
Provider Middle Name:
R.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871514638
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 BIESTERFIELD RD
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
ELK GROVE VILLAGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60007-3361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-981-3660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 BIESTERFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
ELK GROVE VILLAGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60007-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-981-3660
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  D0064481 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X , with the licence number: 036125801 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: 036125801 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 88825101 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 689LO216 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: I59407 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0036 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1314809 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 145724700 . This is a "US DEPT OF LABOR-WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 309207 . This is a "AMERIGROUP - AMERICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 411955000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203509 . This is a "JHHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 259230 . This is a "KAISER PERMANENTE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7958800 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00332120 . This is a "RAILROAD MEDICARE-PALMETTO" identifier . This identifiers is of the category "OTHER".




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