Provider Demographics
NPI:1699762328
Name:DESAI, RENUKA N (MD)
Entity type:Individual
Prefix:
First Name:RENUKA
Middle Name:N
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 TOWER CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3376
Mailing Address - Country:US
Mailing Address - Phone:847-623-3200
Mailing Address - Fax:847-623-9168
Practice Address - Street 1:2031 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9041
Practice Address - Country:US
Practice Address - Phone:847-356-5575
Practice Address - Fax:847-356-1792
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36-063209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C42007Medicare UPIN