Basic Information
| Provider Information | |||||||||
| NPI: | 1649409665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAHA | ||||||||
| FirstName: | INDRANI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 STINSON BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554132614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126722258 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10961 CLUB WEST PKWY | ||||||||
| Address2: | |||||||||
| City: | BLAINE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554495866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635282987 | ||||||||
| FaxNumber: | 7635282945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2009 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD60280219 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | H400333131 | 01 | MEDICARE PTAN | OTHER |