Provider Demographics
NPI:1396752283
Name:DESAI, JAYSHREE M (MD)
Entity type:Individual
Prefix:
First Name:JAYSHREE
Middle Name:M
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:36180 FIVE MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-591-7666
Mailing Address - Fax:734-591-2426
Practice Address - Street 1:36180 FIVE MILE ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-591-7666
Practice Address - Fax:734-591-2426
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301056798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3323140Medicaid
F61983Medicare UPIN
MI0M33260Medicare PIN