PROVIDER CONSULTATION | Reno Heart Institute

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Devang M. Desai,MD, FACC, FSCAI

Phone 775-302-0000 Fax 775-993-9111

10623 Professional Circle, Suite A
Reno, NV 89521

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PROVIDER CONSULTATION REQUEST

Patient First Name

Last Name

Patient Phone

Patient Email

Consulting Physician Name and Number

Reason For Consult

Referral Authorization #

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