Provider Demographics
NPI:1083687248
Name:DESAI, SHWETAL G (MD)
Entity type:Individual
Prefix:DR
First Name:SHWETAL
Middle Name:G
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5157 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2622
Mailing Address - Country:US
Mailing Address - Phone:513-863-4717
Mailing Address - Fax:513-863-5118
Practice Address - Street 1:5157 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2622
Practice Address - Country:US
Practice Address - Phone:513-863-4717
Practice Address - Fax:513-863-5118
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0886822Medicaid
OHF13543Medicare UPIN
OH0886822Medicaid