Healthcare Provider Details

I. General information

NPI: 1144422999
Provider Name (Legal Business Name): RAJIB PRATIM SAHA D.O., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N BRICE RD SUITE 300
COLUMBUS OH
43219
US

IV. Provider business mailing address

354 COACHMAN DR APARTMENT 1A
TROY MI
48083-4715
US

V. Phone/Fax

Practice location:
  • Phone: 866-751-5411
  • Fax:
Mailing address:
  • Phone: 248-229-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number34. 008978
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number219069
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number5101016757
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: