Healthcare Provider Details

I. General information

NPI: 1093164055
Provider Name (Legal Business Name): SARAH ADA GENEVIEVE URTON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date: 01/25/2017
Reactivation Date: 02/10/2017

III. Provider practice location address

2900 N. LAKE SHORE DRIVE
CHICAGO IL
60657-6274
US

IV. Provider business mailing address

2208 N CLARK ST APT 310
CHICAGO IL
60614-3847
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-6730
  • Fax:
Mailing address:
  • Phone: 510-704-3167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: