Annemarie Paula Desanto, M.D.
Individual provider Active NPI Surgery Physician · Kokomo, IN
NPI 1104813336 · NPPES record last updated Dec 2, 2024
Key facts
- NPI
- 1104813336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 01037590A (IN)
- Practice address
- 2000 W Boulevard
Kokomo, IN 46902-6079 - Phone
- (765) 456-1790
- Fax
- (765) 457-3561
- NPI assigned
- Oct 3, 2005
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01037590A | IN | MD | Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 01037590A | IN | Yes |
Addresses
Primary practice location
2000 W Boulevard
Kokomo, IN 46902-6079
Mailing address
2644 Caden CT
Westfield, IN 46074-8527
Phone (765) 456-1790
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100103220A | Medicaid | IN |
Other providers in Kokomo, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.