Basic Information
Provider Information
NPI: 1003001884
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAHA
FirstName: LUCILLE
MiddleName: T
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1397 S LINDEN RD
Address2: SUITE A
City: FLINT
State: MI
PostalCode: 485324194
CountryCode: US
TelephoneNumber: 8107209300
FaxNumber:  
Practice Location
Address1: 1397 S LINDEN RD
Address2: SUITE A
City: FLINT
State: MI
PostalCode: 485324194
CountryCode: US
TelephoneNumber: 8107209300
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/13/2007
LastUpdateDate: 11/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X4301061270MIY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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