Provider Demographics
NPI:1891783593
Name:SAUCHAK, JOHN A (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SAUCHAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:SAUCHAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO PC
Mailing Address - Street 1:830 W LAKE LANSING RD
Mailing Address - Street 2:#190
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6371
Mailing Address - Country:US
Mailing Address - Phone:517-333-3777
Mailing Address - Fax:517-203-3948
Practice Address - Street 1:830 W LAKE LANSING RD
Practice Address - Street 2:#190
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6371
Practice Address - Country:US
Practice Address - Phone:517-333-3777
Practice Address - Fax:517-203-3948
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010601207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000001149OtherPHYSICIANS HEALTH PLAN
MI4540938OtherAETNA
MI200C31365OtherBLUECARE NETWORK
MI200C31365OtherBLUE SHIELD
MI4838592Medicaid
MI200C31365OtherBLUECARE NETWORK
G11508Medicare UPIN