Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 38325 | TN |
Y | 207RR0500X | Rheumatology | 38463 | KY |
NPI | 1124005038 |
---|---|
Provider Name | Dr. Kishorkumar A Desai |
First Address | Hopkinsville, KY 42241-1148 |
Second Address | Hopkinsville, KY 42240-1746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 01/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4091796 | (05) | TN |
64081128 | (05) | KY |
I08431 | (02) | KY |