Individual
DR. PREMAL JITENDRA DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5779 E MAYO BLVD, PHOENIX, AZ 85054
(480) 301-8000
Mailing address
5779 E MAYO BLVD, PHOENIX, AZ 85054
(480) 301-8000
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35462
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105224
—
AZ
01
—
P00348653
RAILROAD MEDICARE
AZ
Enumeration date
06/07/2006
Last updated
10/03/2012
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