Provider Demographics
NPI:1417177783
Name:SAITIS, DIANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:SAITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 8TH AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5031
Mailing Address - Country:US
Mailing Address - Phone:262-653-5450
Mailing Address - Fax:262-653-5451
Practice Address - Street 1:6308 8TH AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5031
Practice Address - Country:US
Practice Address - Phone:262-653-5450
Practice Address - Fax:262-653-5451
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52701-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1417177783Medicaid
WI1417177783Medicaid