Healthcare Provider Details

I. General information

NPI: 1033505367
Provider Name (Legal Business Name): SARAH J WILLARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH J BIESER MD

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 E WINDSOR RD
URBANA IL
61802-9564
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3909
US

V. Phone/Fax

Practice location:
  • Phone: 217-344-9440
  • Fax: 217-344-4377
Mailing address:
  • Phone: 217-344-9440
  • Fax: 217-344-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number59098
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: