Healthcare Provider Details

I. General information

NPI: 1295344893
Provider Name (Legal Business Name): PRATIK SAHA M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CHANNING WAY
IDAHO FALLS ID
83404-7533
US

IV. Provider business mailing address

1350 N TOWN CENTER DR UNIT 2013
LAS VEGAS NV
89144-0583
US

V. Phone/Fax

Practice location:
  • Phone: 208-973-2449
  • Fax:
Mailing address:
  • Phone: 510-415-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number9971442
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: