MEDICARE: DR. SARAH MARTIN MENDENHALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558301705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH MARTIN MENDENHALL M.D.

Provider Business Mailing Address
First Line	:	1229 N NORTH BRANCH ST
Second Line	:	#210
City	:	CHICAGO
State	:	IL
Zip	:	60622-2473
Country	:	US
Telephone Number	:	312-939-5090
Fax Number	:	312-640-4496

Provider Business Practice Location Address
First Line	:	1229 N NORTH BRANCH ST
Second Line	:	#210
City	:	CHICAGO
State	:	IL
Zip	:	60622-2473
Country	:	US
Telephone Number	:	312-939-5090
Fax Number	:	312-640-4496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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