Provider Demographics
NPI:1447696000
Name:DAS, SATYA P (RPT)
Entity type:Individual
Prefix:MR
First Name:SATYA
Middle Name:P
Last Name:DAS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 MOREL DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9309
Mailing Address - Country:US
Mailing Address - Phone:231-884-0239
Mailing Address - Fax:
Practice Address - Street 1:1101 N MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1200
Practice Address - Country:US
Practice Address - Phone:231-779-2526
Practice Address - Fax:231-779-6888
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4916957Medicaid
MIOP19110OtherMEDICARE GROUP PROVIDER NO.