Healthcare Provider Details

I. General information

NPI: 1508445487
Provider Name (Legal Business Name): SARA ANN KULLBERG PEARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA ANN KULLBERG MD

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1600
CHICAGO IL
60611-2997
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1600
CHICAGO IL
60611-2997
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8106
  • Fax: 312-695-0664
Mailing address:
  • Phone: 312-695-8106
  • Fax: 312-695-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number125085121
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: