Individual
HETAL DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3700 SOUTHERN BLVD STE 401, KETTERING, OH 45429
(855) 500-2873
(937) 281-3913
Mailing address
1 PRESTIGE PL STE 550, MIAMISBURG, OH 45342-6115
(937) 762-1305
(937) 522-7513
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.002248RX
OH
363AM0700X
Medical Physician Assistant
2248
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110093
—
OH
Enumeration date
06/24/2008
Last updated
12/03/2020
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