Healthcare Provider Details

I. General information

NPI: 1598226748
Provider Name (Legal Business Name): SARAH THANNISCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH MARTIN MD

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 520
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4300 W 7TH ST
LITTLE ROCK AR
72205-5446
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-6627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberE-19547
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-19547
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: