MEDICARE: DR. BASUDEB SAHA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5600195	OTHER	IL	BLUE CROSS

General Provider Information

NPI Number	:	1033144696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASUDEB SAHA MD

Provider Business Mailing Address
First Line	:	4318 L CRYSTAL LAKE RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050
Country	:	US
Telephone Number	:	815-344-0620
Fax Number	:	815-344-0504

Provider Business Practice Location Address
First Line	:	4318 L CRYSTAL LAKE RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050
Country	:	US
Telephone Number	:	815-344-0620
Fax Number	:	815-344-0504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. BASUDEB SAHA MD” Practice Location

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