Healthcare Provider Details

I. General information

NPI: 1407865934
Provider Name (Legal Business Name): SARAH A BRANDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST SUITE 2140
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

1365 PAYSPHERE CIR
CHICAGO IL
60674-0013
US

V. Phone/Fax

Practice location:
  • Phone: 312-664-5400
  • Fax: 312-664-5854
Mailing address:
  • Phone: 847-585-7000
  • Fax: 847-240-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number103329
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: