Provider Demographics
NPI:1255378378
Name:INDIRA R SAXENA MD PC
Entity type:Organization
Organization Name:INDIRA R SAXENA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-463-1472
Mailing Address - Street 1:311 E WARWICK DR
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801
Mailing Address - Country:US
Mailing Address - Phone:989-463-1472
Mailing Address - Fax:989-463-2249
Practice Address - Street 1:311 E WARWICK DR
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801
Practice Address - Country:US
Practice Address - Phone:989-463-1472
Practice Address - Fax:989-463-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419872207V00000X
NM82306207V00000X
MI4301035547207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1602931161OtherFEDERAL BLUE SHIELD AND B
MI2093340Medicaid
MI0293116OtherBLUE CROSS BLUE SHIELD
MI1005767OtherMCLAREN MANAGED MEDICAID
MI0293116OtherBLUE CROSS BLUE SHIELD
MI1005767OtherMCLAREN MANAGED MEDICAID