Provider Demographics
NPI:1780880831
Name:SAXENA, SUMESH (BS)
Entity type:Individual
Prefix:
First Name:SUMESH
Middle Name:
Last Name:SAXENA
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 POINTE DR
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7046
Mailing Address - Country:US
Mailing Address - Phone:314-814-5595
Mailing Address - Fax:
Practice Address - Street 1:815 N LARKIN AVE
Practice Address - Street 2:207
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3438
Practice Address - Country:US
Practice Address - Phone:314-814-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist