=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295871184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR SUKAMAL SAHA MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 04/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 CALKINS RD SUITE A
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-230-9600
-----------------------------------------------------
Fax | 810-230-9607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 CALKINS RD SUITE A
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-3506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-230-9600
-----------------------------------------------------
Fax | 810-230-9607
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | SUKAMAL SAHA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 810-230-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086X0206X
-----------------------------------------------------
Taxonomy Name | Surgical Oncology Physician
-----------------------------------------------------
License Number | 4301058150
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------