Provider Demographics
NPI:1750317285
Name:JAGNESWAR SAHA DO PC
Entity Type:Organization
Organization Name:JAGNESWAR SAHA DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGNESWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHA
Authorized Official - Suffix:
Authorized Official - Credentials:DO PHD
Authorized Official - Phone:313-865-2020
Mailing Address - Street 1:211 ALENDALE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3231
Mailing Address - Country:US
Mailing Address - Phone:313-865-2020
Mailing Address - Fax:313-866-2413
Practice Address - Street 1:211 ALENDALE
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3231
Practice Address - Country:US
Practice Address - Phone:313-865-2020
Practice Address - Fax:313-866-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4197263Medicaid
MI4197263Medicaid
E26184Medicare UPIN