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General NPI Number Information
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NPI Number | 1932141306
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Entity Type | Organization
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Legal Business Name | SAI K. SISTA MD, PLLC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 44000 W 12 MILE RD SUITE 212
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City | NOVI
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State | MI
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Zip | 48377-2644
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Country | US
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Telephone | 248-344-0400
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Fax | 248-347-8215
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Provider Business Mailing Address
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Address Line | 44000 W 12 MILE RD SUITE 212
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City | NOVI
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State | MI
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Zip | 48377-2644
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Country | US
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Telephone | 248-344-0400
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Fax | 248-347-8215
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | SAI SISTA
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Credential | MD
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Telephone | 248-344-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301034917
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License Number State | MI
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