Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD435039 | PA |
N | 111NI0900X | Internist | MD435039 | PA |
N | 207RC0000X | Internist - Cardiovascular Disease | 036122578 | IL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036122578 | IL |
NPI | 1275698144 |
---|---|
Provider Name | Paban Saha |
First Address | O Fallon, IL 62269-1282 |
Second Address | O Fallon, IL 62269-1282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036122578 | (05) | IL |
P01355015 | RAILROAD (01) | IL |