Provider Demographics
NPI:1710200530
Name:MICHAEL J. SASEVICH, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL J. SASEVICH, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CARDIOTHORACIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SASEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-632-8400
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-0600
Mailing Address - Country:US
Mailing Address - Phone:760-632-8400
Mailing Address - Fax:760-632-8448
Practice Address - Street 1:1200 GARDEN VIEW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2477
Practice Address - Country:US
Practice Address - Phone:760-632-8400
Practice Address - Fax:760-632-8448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-08
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85960208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1629271200OtherPHYSICIAN INDIVIDUAL NPI NUMBER