Individual
DR. MANISH I DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5909 W 35TH ST, CICERO, IL 60804-4163
(708) 652-2040
(708) 652-0058
Mailing address
5909 W 35TH ST, CICERO, IL 60804-4163
(708) 652-2040
(708) 652-0058
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036105725
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036105725
BLUE SHIELD
IL
05
—
036105725
—
IL
01
—
110234946
RR MEDICARE PIN
IL
01
—
289581
WELLCARE HMO
IL
01
—
843
CHICAGO HEALTH SYSTEMS (CHS)
IL
Enumeration date
06/15/2005
Last updated
06/27/2012
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