Provider Demographics
NPI:1215202429
Name:DESAI, AMISH HARISH (MD)
Entity type:Individual
Prefix:
First Name:AMISH
Middle Name:HARISH
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 1:636 RAYMOND DR STE 306
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9792
Mailing Address - Country:US
Mailing Address - Phone:331-732-4500
Mailing Address - Fax:331-732-4505
Practice Address - Street 1:180 HARVESTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7594
Practice Address - Country:US
Practice Address - Phone:773-702-1150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137953208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist