Provider Demographics
NPI:1487944963
Name:DESAI, PRATIK (MD)
Entity type:Individual
Prefix:
First Name:PRATIK
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 SW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4809
Mailing Address - Country:US
Mailing Address - Phone:862-571-0767
Mailing Address - Fax:
Practice Address - Street 1:3700 CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7649
Practice Address - Country:US
Practice Address - Phone:239-387-1587
Practice Address - Fax:239-666-7786
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286869207L00000X
FLME146802207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111384500Medicaid