Provider Demographics
NPI:1629325634
Name:SAKKAL, SAAD (MD)
Entity Type:Individual
Prefix:
First Name:SAAD
Middle Name:
Last Name:SAKKAL
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 1:4102 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8793
Mailing Address - Country:US
Mailing Address - Phone:513-863-6463
Mailing Address - Fax:513-863-2440
Practice Address - Street 1:5992 BERRYHILL RD STE 104
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-1018
Practice Address - Country:US
Practice Address - Phone:850-564-6192
Practice Address - Fax:850-764-6690
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119454207RE0101X
OH35-048933207R00000X, 207RE0101X
KY45727207R00000X, 207RE0101X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022771100Medicaid
KY7100230440Medicaid
OH0076811Medicaid
OHH409920Medicare PIN
OHH409924Medicare PIN