Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 54299 | KY |
N | 2084N0402X | Child Neurologist | 54299 | KY |
NPI | 1154707057 |
---|---|
Provider Name | Jeetendra Sah |
First Address | Chicago, IL 60677-6879 |
Second Address | Louisville, KY 40202-1713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2015 |
Last Update Date | 01/07/2021 |