Provider Demographics
NPI:1699063644
Name:SAHA, POORNIMA (MD)
Entity type:Individual
Prefix:
First Name:POORNIMA
Middle Name:
Last Name:SAHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:POORNIMA
Other - Middle Name:
Other - Last Name:CHENNAMANENI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:KELLOGG CANCER CENTER
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2112
Mailing Address - Fax:847-570-1041
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:KELLOGG CANCER CENTER
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2112
Practice Address - Fax:847-570-1041
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135237207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology