Provider Demographics
NPI:1982641247
Name:JOHN, SAJI (MD)
Entity Type:Individual
Prefix:
First Name:SAJI
Middle Name:
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851323
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1323
Mailing Address - Country:US
Mailing Address - Phone:972-216-9511
Mailing Address - Fax:972-216-9580
Practice Address - Street 1:2800 SHORELINE WAY
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4162
Practice Address - Country:US
Practice Address - Phone:972-216-9511
Practice Address - Fax:972-216-9580
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9383207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT043095OtherCT LICENSE #
CT043095OtherCT LICENSE #