MEDICARE: SAADEH A SAADEH MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC9339	OTHER	AZ	RAIL ROAD MEDICARE

General Provider Information

NPI Number	:	1548281629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAADEH A SAADEH MD PC

Provider Business Mailing Address
First Line	:	PO BOX 3270
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86405-3270
Country	:	US
Telephone Number	:	928-505-4661
Fax Number	:	928-505-4699

Provider Business Practice Location Address
First Line	:	1851 MESQUITE AVE
Second Line	:	SUITE 112
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5677
Country	:	US
Telephone Number	:	928-505-4661
Fax Number	:	928-505-4699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAADEH A SAADEH
Credential	:	MD
Telephone Number	:	928-505-4661

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	11/07/2007

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