Provider Demographics
NPI:1518607001
Name:DESAI, YATRI (DO)
Entity type:Individual
Prefix:DR
First Name:YATRI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27655 W IL ROUTE 120
Practice Address - Street 2:
Practice Address - City:LAKEMOOR
Practice Address - State:IL
Practice Address - Zip Code:60051-8003
Practice Address - Country:US
Practice Address - Phone:815-458-1500
Practice Address - Fax:815-458-1501
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU9502207Q00000X
IL036-175680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine