Individual
SHAILESH DHIRUBHAI DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
240 NORTH RERICK AVE, PRIMGHAR, IA 51245
(712) 957-2310
(712) 957-0504
Mailing address
PO BOX 324, SIOUX CITY, IA 51102-0324
(712) 279-5830
(712) 279-5883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31556
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2145151
—
IA
01
—
22768
SIOUX VALLEY HEALTH PLAN
IA
05
—
3145151
—
IA
05
—
4145151
—
IA
01
—
48073
WELLMARK BCBS IA
IA
05
—
5145151
—
IA
Enumeration date
04/11/2006
Last updated
10/17/2007
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