Provider Demographics
NPI:1194750349
Name:DESAI, NILESH H (MD)
Entity type:Individual
Prefix:DR
First Name:NILESH
Middle Name:H
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1825
Mailing Address - Country:US
Mailing Address - Phone:818-848-5561
Mailing Address - Fax:818-563-4376
Practice Address - Street 1:241 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1825
Practice Address - Country:US
Practice Address - Phone:818-848-5561
Practice Address - Fax:818-563-4376
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33861207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A33861Medicaid
CAWA33861BMedicare PIN
CA00A33861Medicaid