Basic Information
| Provider Information | |||||||||
| NPI: | 1588928642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAGUN | ||||||||
| FirstName: | GENEVA | ||||||||
| MiddleName: | ALINCASTRE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 14 | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490810014 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4613 W MAIN ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490062645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694888672 | ||||||||
| FaxNumber: | 2694888673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2012 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301101658 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | 4301101658 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 4301101658 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.