Provider Demographics
NPI:1093765620
Name:DESAI, MINA C (MD)
Entity type:Individual
Prefix:MS
First Name:MINA
Middle Name:C
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S. BRYAN ROAD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6613
Mailing Address - Country:US
Mailing Address - Phone:956-323-1808
Mailing Address - Fax:956-323-1817
Practice Address - Street 1:900 S. BRYAN ROAD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6613
Practice Address - Country:US
Practice Address - Phone:956-323-1808
Practice Address - Fax:956-323-1817
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9064207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126537305Medicaid
TX86670KMedicare ID - Type UnspecifiedMEDICARE
TXF48496Medicare UPIN