Provider Demographics
NPI:1932392693
Name:SABIITI, JESSE M (MD)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:M
Last Name:SABIITI
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:PO BOX 5010
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5010
Mailing Address - Country:US
Mailing Address - Phone:701-857-5650
Mailing Address - Fax:701-857-5031
Practice Address - Street 1:307 1ST AVE. NW
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746
Practice Address - Country:US
Practice Address - Phone:701-385-4283
Practice Address - Fax:701-385-4282
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44710207R00000X
ORMD217211208M00000X
NC2016-00142208M00000X
ND10658207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100178620Medicaid
KY000000729955OtherBCBS
KYP00977424OtherRR MEDICARE
KY000000729955OtherBCBS
OHH410110Medicare PIN