Provider Demographics
NPI:1861632861
Name:SAVANT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SAVANT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAVANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-387-8031
Mailing Address - Street 1:1 SHRADER ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1016
Mailing Address - Country:US
Mailing Address - Phone:415-387-8031
Mailing Address - Fax:415-668-8325
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:SUITE 550
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1016
Practice Address - Country:US
Practice Address - Phone:415-387-8031
Practice Address - Fax:415-668-8325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP38281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty