MEDICARE: SANDRA H GARRETSON MD

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	036073462	IL
2	207R00000X	Internal Medicine Physician	036-073462	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110227220	OTHER	IL	RAILROAD MEDICARE
3	L88004	OTHER	IL	MEDICARE LEGACY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-073462	OTHER	IL	LICENSE #

General Provider Information

NPI Number	:	1851337026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA H GARRETSON MD

Provider Business Mailing Address
First Line	:	405 LAKE ZURICH RD
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3141
Country	:	US
Telephone Number	:	847-381-5599
Fax Number	:	847-381-1431

Provider Business Practice Location Address
First Line	:	405 LAKE ZURICH RD
Second Line	:
City	:	BARRINGTON
State	:	IL
Zip	:	60010-3141
Country	:	US
Telephone Number	:	847-381-5599
Fax Number	:	847-381-1431

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	03/01/2017

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