Basic Information
| Provider Information | |||||||||
| NPI: | 1427019843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SASSE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3686 GRANDVIEW PKWY STE 720 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352433408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0597175002 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3686 GRANDVIEW PKWY STE 720 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352433408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059717500 | ||||||||
| FaxNumber: | 2059717571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 48228 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 31616 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 51125172 | 01 | AL | BCBS | OTHER | P01068510 | 01 | RAILROAD/TRAVELERS | OTHER | 00358331 | 05 | MS | MEDICAID | 138658 | 05 | AL | MEDICAID |