Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036100458 | IL |
Y | 111NI0900X | Internist | 036100458 | IL |
N | 207RG0300X | Geriatric Medicine | 036100458 | IL |
NPI | 1063556991 |
---|---|
Provider Name | Bela D Desai |
First Address | Des Plaines, IL 60017-1935 |
Second Address | Des Plaines, IL 60016-1005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 17/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036100458 | (05) | IL |
H13499 | (02) |