MIRA DESAI (NPI# 1538559190) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538559190 |
| Entity Type | Individual |
| Full Name | MIRA DESAI |
| Credential | AGPCNP |
| Practice Address |
3046 127th St Blue Island IL 60406-1827 |
| Mailing Address |
213 N Racine Ave Chicago IL 60607-1644 |
| Practice Telephone | 7083777920 |
| Practice Fax Number | 7089300414 |
| Mailing Telephone | 3127339730 |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-10-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
041426832 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3046 127TH ST |
| City | BLUE ISLAND |
| State | IL |
| Zip Code | 60406-1827 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508181108 | Francina Miguelina Peralta Machado | Internal Medicine | 3046 127th St, Blue Island, IL 60406-1827 | 2010-04-07 |
| 1245899749 | Angela Merari Martinez | Nurse Practitioner | 3046 127th St, Blue Island, IL 60406-1827 | 2019-06-07 |
| 1679038186 | Doris Fandohan | Nurse Practitioner | 3046 127th St, Blue Island, IL 60406-1827 | 2019-02-08 |
| 1023545464 | Imani Alima Ibrahim | Social Worker | 3046 127th St, Blue Island, IL 60406-1827 | 2017-05-16 |
| 1023549821 | Patrick Hines | Family Medicine | 3046 127th St, Blue Island, IL 60406-1827 | 2017-03-23 |
| 1942677984 | Ashton N Forsythe | Nurse Practitioner | 3046 127th St, Blue Island, IL 60406-1827 | 2015-08-25 |
| 1770970931 | John Thomas Matera | Internal Medicine | 3046 127th St, Blue Island, IL 60406-1827 | 2015-04-24 |
| 1275952731 | Avinash Mantha | Family Medicine | 3046 127th St, Blue Island, IL 60406-1827 | 2014-04-14 |
| 1720374002 | Eric Aguinaldo | Internal Medicine | 3046 127th St, Blue Island, IL 60406-1827 | 2011-06-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780205708 | Cook County | Family Medicine | 12757 S. Western Ave, Blue Island, IL 60406 | 2020-04-30 |
| 1942842810 | Blue Island Smiles PC | Dentist | 12059 Western Avenue, Blue Island, IL 60406 | 2019-10-12 |
| 1609438738 | Maisha Safford | Developmental Therapist | 2262 W. 120th Place, Blue Island, IL 60406 | 2019-06-28 |
| 1891279709 | Renjith Thomas | Physical Therapy Assistant | Therapy Department, 1546 W Water Stret, Blue Island, IL 60406 | 2018-09-18 |
| 1982182994 | Lifehouse Health Group,llc | Clinic/Center | 14127 Levitt Ave, Dixmoor, IL 60406 | 2018-08-01 |
| 1063923159 | Sarah Lynn Presser | Speech-Language Pathologist | 2975 W Broadway, Blue Island, IL 60406 | 2017-10-17 |
| 1174070676 | Aunt Martha's Youth Service Center | Clinic/Center | 12139 S. Western Ave, Blue Island, IL 60406 | 2016-09-01 |
| 1427429141 | Pamela Kilcrease | Case Manager/Care Coordinator | 2247 119th Street, Apt 6, Blue Island, IL 60406 | 2015-10-08 |
| 1639587025 | D2 Dental At Oak Street, P.C. | Dentist | 3046 West 127th Street, Blue Island, IL 60406 | 2014-07-29 |
| 1700299658 | Daniel Ahrens | Optometrist | 13114 S Western Ave, Blue Island, IL 60406 | 2014-06-09 |
| Find all providers in zip 60406 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225636475 | Monika Sitko | Nurse Practitioner | 3 E 14th Pl, Lombard, IL 60148-4574 | 2020-10-10 |
| 1134735343 | Michael Fitz | Nurse Practitioner | 6205 Westminster Ct, Springfield, IL 62711-6728 | 2020-09-22 |
| 1013521038 | Eziaha R Georgewill | Nurse Practitioner | 17800 Kedzie Ave # A, Hazel Crest, IL 60429-2029 | 2020-09-08 |
| 1447870274 | 15 Park Place LLC | Nurse Practitioner | 15 Park Pl Ste 1, Swansea, IL 62226-2918 | 2020-04-22 |
| 1861021248 | Elizabeth Horan | Nurse Practitioner | 125 S Green St Apt 1005a, Chicago, IL 60607-3717 | 2020-04-07 |
| 1699315697 | Kelsey L Proehl | Nurse Practitioner | 70 Meadowview Ctr Ste 300, Kankakee, IL 60901-2062 | 2020-01-08 |
| 1992343248 | Maryanne M Smith | Nurse Practitioner | 805 W Deyoung St Ste D, Marion, IL 62959-1602 | 2019-12-17 |
| 1730724451 | Suzana None Nikitovic | Nurse Practitioner | 2815 Regner Rd, Mchenry, IL 60051-6942 | 2019-11-18 |
| 1104461870 | Swanson Family Practice LLC | Nurse Practitioner | 733 N Logan Ave Ste 1, Danville, IL 61832-4378 | 2019-11-16 |
| 1205471083 | Sylvia Coleman | Nurse Practitioner | 20 W Kinzie St Ste 17, Chicago, IL 60654-6393 | 2019-11-15 |
| Find all providers with the same taxonomy | ||||
| City | BLUE ISLAND |
| Zip Code | 60406 |
Please comment or provide details below to improve the information on MIRA DESAI.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.