Provider Demographics
NPI:1972780781
Name:DISU, SAKA ROTIMI (MD)
Entity type:Individual
Prefix:DR
First Name:SAKA
Middle Name:ROTIMI
Last Name:DISU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 SPRING VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704
Mailing Address - Country:US
Mailing Address - Phone:304-429-6741
Mailing Address - Fax:304-429-0262
Practice Address - Street 1:1540 SPRING VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-6741
Practice Address - Fax:304-429-0262
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2460002083P0500X, 208D00000X
FLME100539208D00000X
KY41695208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine