Provider Demographics
NPI:1295058865
Name:DESAI, JIGAR V
Entity type:Individual
Prefix:MR
First Name:JIGAR
Middle Name:V
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JIGARKUMAR
Other - Middle Name:V
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8118 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2817
Mailing Address - Country:US
Mailing Address - Phone:847-518-0750
Mailing Address - Fax:
Practice Address - Street 1:8118 N MILWAUKEE AVE
Practice Address - Street 2:104
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2817
Practice Address - Country:US
Practice Address - Phone:847-518-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38345183500000X
MI5302032526183500000X
IL051-288719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist