Provider Demographics
NPI:1992741227
Name:DESAI, SUDHIR L (MD)
Entity type:Individual
Prefix:
First Name:SUDHIR
Middle Name:L
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 1:126 COLLEGE ST
Mailing Address - Street 2:STE A
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3461
Mailing Address - Country:US
Mailing Address - Phone:269-969-6254
Mailing Address - Fax:269-969-8793
Practice Address - Street 1:126 COLLEGE ST
Practice Address - Street 2:STE A
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3461
Practice Address - Country:US
Practice Address - Phone:269-969-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISD046833207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1944457Medicaid
MI0130059Medicare ID - Type Unspecified
MI1944457Medicaid