MEDICARE: BASUDEB SAHA MD SC

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	036052882	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851613947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASUDEB SAHA MD SC

Provider Business Mailing Address
First Line	:	4318 W CRYSTAL LAKE RD
Second Line	:	SUITE L
City	:	MCHENRY
State	:	IL
Zip	:	60050-4210
Country	:	US
Telephone Number	:	815-344-0620
Fax Number	:	815-344-0504

Provider Business Practice Location Address
First Line	:	4318 W CRYSTAL LAKE RD
Second Line	:	SUITE L
City	:	MCHENRY
State	:	IL
Zip	:	60050-4210
Country	:	US
Telephone Number	:	815-344-0620
Fax Number	:	815-344-0504

Authorized Official
Title or Position	:	MD SC
Name	:	DR. BASUDEB SAHA
Credential	:	MD
Telephone Number	:	815-344-0620

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	06/15/2010

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