Organization
MANISHA DESAI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MANISHA MAHADEV DESAI M.D. (ORGANIZATION OWNER/PROPRIETER)
(432) 580-0985
Entity
Organization
Contact information
Practice address
400 EAST 6TH STREET STE 100, ODESSA, TX 79761-6947
(432) 580-0985
(432) 337-2666
Mailing address
420 EAST 6TH STREET STE 100, ODESSA, TX 79761-6947
(432) 580-0985
(432) 337-2666
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K6561
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09226801
—
TX
05
—
09226802
—
TX
Enumeration date
09/12/2017
Last updated
09/12/2017
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