Healthcare Provider Details

I. General information

NPI: 1306067533
Provider Name (Legal Business Name): SACHARITHA BOWERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST SUITE 2300
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

PO BOX 19644
SPRINGFIELD IL
62794-9644
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-4485
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036-136349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: