Basic Information
| Provider Information | |||||||||
| NPI: | 1144309287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | HEMLATTA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6800 E 10 MILE RD | ||||||||
| Address2: | |||||||||
| City: | CENTER LINE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480151167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5866199986 | ||||||||
| FaxNumber: | 5868065085 | ||||||||
| Practice Location | |||||||||
| Address1: | 43740 N GROESBECK HWY | ||||||||
| Address2: | |||||||||
| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5864930961 | ||||||||
| FaxNumber: | 5864931001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 4301041697 | MI | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 1653585 | 05 | MI | MEDICAID |