Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 18708 | KY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 18708 | KY |
NPI | 1144285297 |
---|---|
Provider Name | Sibu Saha |
First Address | Lexington, KY 40536-0284 |
Second Address | Lexington, KY 40536-0284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 28/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18708 | KENTUCKY BOARD OF MEDICAL LICENSURE (01) | KY |
64187081 | (05) | KY |
C68200 | (02) |