Provider Demographics
NPI:1780778753
Name:SAHA, ASIS KUMAR (MD PA)
Entity type:Individual
Prefix:DR
First Name:ASIS
Middle Name:KUMAR
Last Name:SAHA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 HILDA ST
Mailing Address - Street 2:SUITE #10
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2320
Mailing Address - Country:US
Mailing Address - Phone:407-846-3426
Mailing Address - Fax:407-846-6701
Practice Address - Street 1:201 HILDA ST
Practice Address - Street 2:SUITE #10
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2320
Practice Address - Country:US
Practice Address - Phone:407-846-3426
Practice Address - Fax:407-846-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18450174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD59589Medicare UPIN