Provider Demographics
NPI:1932141306
Name:SAI K. SISTA MD, PLLC
Entity Type:Organization
Organization Name:SAI K. SISTA MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAI
Authorized Official - Middle Name:
Authorized Official - Last Name:SISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-344-0400
Mailing Address - Street 1:44000 W 12 MILE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2644
Mailing Address - Country:US
Mailing Address - Phone:248-344-0400
Mailing Address - Fax:248-347-8215
Practice Address - Street 1:44000 W 12 MILE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2644
Practice Address - Country:US
Practice Address - Phone:248-344-0400
Practice Address - Fax:248-347-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034917207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDQ4870OtherRAILROAD MEDICARE
MI1932141306Medicaid
MI100F338440OtherBC GROUP
MI100F338440OtherBCN GROUP
MI1932141306Medicaid
MI100F338440OtherBCN GROUP