Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25014 | MS |
N | 207Q00000X | Family Doctor | 48776 | TN |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 25014 | MS |
N | 208D00000X | General Practice Physician | 25014 | MS |
N | 208D00000X | General Practice Physician | 48776 | TN |
NPI | 1700088085 |
---|---|
Provider Name | Kallol Kumar Saha |
First Address | Collierville, TN 38017-9740 |
Second Address | Southaven, MS 38671-1610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 19/07/2019 |