Provider Demographics
NPI:1699874677
Name:SAHA, JOYANTA KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:JOYANTA
Middle Name:KUMAR
Last Name:SAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43361 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1109
Mailing Address - Country:US
Mailing Address - Phone:586-263-7190
Mailing Address - Fax:586-263-7177
Practice Address - Street 1:43361 COMMONS DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1109
Practice Address - Country:US
Practice Address - Phone:586-263-7190
Practice Address - Fax:586-263-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4144386-10Medicaid
MI1105008501OtherBLUE CROSS BLUE SHIELD
MI0M89570Medicare ID - Type Unspecified
MIF04729Medicare UPIN