Provider Demographics
NPI:1588685663
Name:SAADEH, SAADEH A (MD)
Entity Type:Individual
Prefix:
First Name:SAADEH
Middle Name:A
Last Name:SAADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1739 E BEVERLY AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-3593
Mailing Address - Country:US
Mailing Address - Phone:928-718-1511
Mailing Address - Fax:928-718-1511
Practice Address - Street 1:1739 E BEVERLY AVE STE 217
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3593
Practice Address - Country:US
Practice Address - Phone:928-718-1511
Practice Address - Fax:928-718-1511
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27617207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ060066106OtherRAIL ROAD PROV NUMBER
AZAZ0883140OtherBCBS
AZ470261Medicaid
F92060Medicare UPIN
AZ470261Medicaid