Healthcare Provider Details

I. General information

NPI: 1144268061
Provider Name (Legal Business Name): KIMITAKA SAITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 NEWSOME DR
MARKED TREE AR
72365-2021
US

IV. Provider business mailing address

PO BOX 616
MARKED TREE AR
72365-0616
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-4355
  • Fax: 870-358-4357
Mailing address:
  • Phone: 870-358-4355
  • Fax: 870-358-4357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-2736
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: