Provider Demographics
NPI:1295871184
Name:DR SUKAMAL SAHA MD PC
Entity type:Organization
Organization Name:DR SUKAMAL SAHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUKAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-230-9600
Mailing Address - Street 1:3500 CALKINS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3506
Mailing Address - Country:US
Mailing Address - Phone:810-230-9600
Mailing Address - Fax:810-230-9607
Practice Address - Street 1:3500 CALKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3506
Practice Address - Country:US
Practice Address - Phone:810-230-9600
Practice Address - Fax:810-230-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010581502086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103118229Medicaid
MI0254832OtherBLUE CROSS
MI4301058150OtherHEALTHPLUS
MI203989OtherMCLAREN HEALTH PLAN
MI910000098OtherMEDICARE RAILROAD
MI203989OtherMCLAREN HEALTH ADVANTAGE
MI0254832OtherBLUE CARE NETWORK
MIC3827OtherMCARE
MIC3827OtherMCARE
MI203989OtherMCLAREN HEALTH ADVANTAGE