Provider Demographics
NPI:1366527574
Name:SAKSENA, PREM N (MD)
Entity type:Individual
Prefix:
First Name:PREM
Middle Name:N
Last Name:SAKSENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:731 MARTIN RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2703
Practice Address - Country:US
Practice Address - Phone:817-514-0346
Practice Address - Fax:817-514-0885
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1183208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123977401Medicaid
TX86W431OtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TX4019562OtherAETNA PIN
TX8425149OtherCIGNA PIN
TX1640384OtherFIRSTHEALTH PIN
1750369203OtherGRP NPI NUMBER
TX137345811Medicaid
TXSAKPB26114OtherCCHIP PIN
TX920765OtherUHC PIN
TX137345804Medicaid
B26114Medicare UPIN
TXSAKPB26114OtherCCHIP PIN
TX123977401Medicaid