Individual
TINA R. DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 702-6128
Mailing address
5841 S MARYLAND AVE, CHICAGO, IL 60637-1447
(773) 702-6128
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
036087065
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-087065
STATE LICENSE
IL
Enumeration date
11/06/2006
Last updated
02/19/2010
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