Provider Demographics
NPI:1851613947
Name:BASUDEB SAHA MD SC
Entity Type:Organization
Organization Name:BASUDEB SAHA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD SC
Authorized Official - Prefix:DR
Authorized Official - First Name:BASUDEB
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-344-0620
Mailing Address - Street 1:4318 W CRYSTAL LAKE RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4210
Mailing Address - Country:US
Mailing Address - Phone:815-344-0620
Mailing Address - Fax:815-344-0504
Practice Address - Street 1:4318 W CRYSTAL LAKE RD
Practice Address - Street 2:SUITE L
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4210
Practice Address - Country:US
Practice Address - Phone:815-344-0620
Practice Address - Fax:815-344-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052882208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052882Medicaid
ILC37293Medicare UPIN