Basic Information
| Provider Information | |||||||||
| NPI: | 1548464696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | MANDAR | ||||||||
| MiddleName: | PRAMOD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787024237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575537099 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 W BEN WHITE BLVD | ||||||||
| Address2: | SOUTH AUSTIN MEDICAL CENTER | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787046903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124472211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | TRN11660 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 063312 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | ME105634 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | N6856 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.