Provider Demographics
NPI:1144268061
Name:SAITO, KIMITAKA (MD)
Entity type:Individual
Prefix:
First Name:KIMITAKA
Middle Name:
Last Name:SAITO
Suffix:
Gender:M
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:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:MARKED TREE
Mailing Address - State:AR
Mailing Address - Zip Code:72365-0616
Mailing Address - Country:US
Mailing Address - Phone:870-358-4355
Mailing Address - Fax:870-358-4357
Practice Address - Street 1:202 NEWSOME DR
Practice Address - Street 2:
Practice Address - City:MARKED TREE
Practice Address - State:AR
Practice Address - Zip Code:72365-2021
Practice Address - Country:US
Practice Address - Phone:870-358-4355
Practice Address - Fax:870-358-4357
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
710852165-001OtherPRUDENTIAL
7052174OtherAETNA
17411000000OtherQUALCHOICE
AR54639OtherARBCBS
710852165-001OtherCIGNA
710852165-001OtherPRUDENTIAL
ARB90545Medicare UPIN