Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 036.123836 | IL |
NPI | 1013125079 |
---|---|
Provider Name | Anu Gupta Desai |
First Address | Lafayette, LA 70503 |
Second Address | Lafayette, LA 70503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 25/07/2019 |