Basic Information
| Provider Information | |||||||||
| NPI: | 1508090234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | CHAITANYA | ||||||||
| MiddleName: | RAJENDRA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 W 22ND ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605231563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305735000 | ||||||||
| FaxNumber: | 7084227816 | ||||||||
| Practice Location | |||||||||
| Address1: | 9125 S PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608051441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084227715 | ||||||||
| FaxNumber: | 7084227816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2009 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036131408 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 036.131408 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.