Healthcare Provider Details

I. General information

NPI: 1154701985
Provider Name (Legal Business Name): RAID SACO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2015
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22060 BEECH ST STE 200
DEARBORN MI
48124-2853
US

IV. Provider business mailing address

22060 BEECH ST STE 200
DEARBORN MI
48124-2853
US

V. Phone/Fax

Practice location:
  • Phone: 313-228-0505
  • Fax:
Mailing address:
  • Phone: 313-228-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301107946
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number4301107946
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301107946
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: