Organization
EASTERN IDAHO INTENSIVIST LLC
Active
Organization
EASTERN IDAHO INTENSIVIST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIT DESAI MD (CEO)
(813) 530-5043
Entity
Organization
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(813) 940-7874
Mailing address
PO BOX 21647, TAMPA, FL 33622-1647
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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