Provider Demographics
NPI:1396752564
Name:DESAI, MUKESH BATUBHAI (MD)
Entity type:Individual
Prefix:
First Name:MUKESH
Middle Name:BATUBHAI
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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0148
Mailing Address - Country:US
Mailing Address - Phone:270-730-5344
Mailing Address - Fax:270-504-1380
Practice Address - Street 1:1215 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1619
Practice Address - Country:US
Practice Address - Phone:270-730-5344
Practice Address - Fax:270-298-5285
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32753208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64327539Medicaid
KYK018983Medicare PIN
KYG46264Medicare UPIN
KY64327539Medicaid
KYK018981Medicare PIN