Provider Demographics
NPI:1699726919
Name:DESAI, CHANDRAKANT C (MD)
Entity type:Individual
Prefix:
First Name:CHANDRAKANT
Middle Name:C
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43902 WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5021
Mailing Address - Country:US
Mailing Address - Phone:248-955-9949
Mailing Address - Fax:248-928-2274
Practice Address - Street 1:43902 WOODWARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5021
Practice Address - Country:US
Practice Address - Phone:248-955-9949
Practice Address - Fax:489-282-2742
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010415372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104142837Medicaid
MI0631986Medicare PIN
MIB45194Medicare UPIN