Provider Demographics
NPI:1659944346
Name:DESAI, VIRMITRA GOVINDBHAI
Entity type:Individual
Prefix:
First Name:VIRMITRA
Middle Name:GOVINDBHAI
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-6880
Mailing Address - Country:US
Mailing Address - Phone:989-894-3297
Mailing Address - Fax:989-891-8147
Practice Address - Street 1:1900 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6880
Practice Address - Country:US
Practice Address - Phone:989-894-3297
Practice Address - Fax:989-891-8147
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301510784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty