Provider Demographics
NPI:1053388777
Name:SAIFUDDIN, TAHIRA (MD)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:
Last Name:SAIFUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11035 W SYCAMORE HILLS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9310
Mailing Address - Country:US
Mailing Address - Phone:260-241-1233
Mailing Address - Fax:260-373-9740
Practice Address - Street 1:360 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3985
Practice Address - Country:US
Practice Address - Phone:207-907-3550
Practice Address - Fax:207-907-3562
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD23200207RG0100X, 207RG0100X
IN01061185A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00286425OtherRAILROAD
IN200800540Medicaid
OH2649567Medicaid
IN000000672226OtherANTHEM
IN000000382926OtherANTHEM
INP00878854OtherMEDICARE RR
IN200800540Medicaid
IN925060A8Medicare PIN
OH2649567Medicaid