Healthcare Provider Details

I. General information

NPI: 1184102618
Provider Name (Legal Business Name): EMILY SAHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 2140
CHICAGO IL
60611-3143
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 2140
CHICAGO IL
60611-3143
US

V. Phone/Fax

Practice location:
  • Phone: 312-472-1234
  • Fax: 312-695-3644
Mailing address:
  • Phone: 312-472-1234
  • Fax: 312-695-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006686
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number085.006686
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: