Basic Information
| Provider Information | |||||||||
| NPI: | 1689808149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESAI | ||||||||
| FirstName: | SNEHAL | ||||||||
| MiddleName: | SUBODH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6565 FANNIN ST | ||||||||
| Address2: | DB 1-007 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134414800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7200 CAMBRIDGE STREET | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137981750 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | N4377 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | BP20029203 | TX | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1689808149 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 8FU661 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 285779906 | 05 | TX | MEDICAID | 285779904 | 05 | TX | MEDICAID |