Basic Information
Provider Information
NPI: 1467866475
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DESAI
FirstName: NIMIT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 351 DELNOR DR STE 351
Address2:  
City: GENEVA
State: IL
PostalCode: 601344222
CountryCode: US
TelephoneNumber: 7346584880
FaxNumber:  
Practice Location
Address1: 351 DELNOR DR STE 351
Address2:  
City: GENEVA
State: IL
PostalCode: 601344222
CountryCode: US
TelephoneNumber: 6302320280
FaxNumber: 6302323896
Other Information
ProviderEnumerationDate: 06/17/2014
LastUpdateDate: 11/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X125065332ILN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X036142269ILN Allopathic & Osteopathic PhysiciansHospitalist 
207RC0000X036142269ILY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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