Provider Demographics
NPI:1699782748
Name:DESAI, VIVEK S (MD)
Entity type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:S
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5900 S JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3716
Mailing Address - Country:US
Mailing Address - Phone:407-398-6470
Mailing Address - Fax:407-894-6872
Practice Address - Street 1:5900 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3716
Practice Address - Country:US
Practice Address - Phone:407-398-6470
Practice Address - Fax:407-894-6872
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2017-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME615212080P0203X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370410601Medicaid
FL370410601Medicaid
FL17722ZMedicare ID - Type Unspecified