Healthcare Provider Details

I. General information

NPI: 1326524455
Provider Name (Legal Business Name): SARAH IMMELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH CLARK

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST STE 301
DULUTH MN
55805-2225
US

IV. Provider business mailing address

920 E 1ST ST STE 301
DULUTH MN
55805-2225
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-6279
  • Fax:
Mailing address:
  • Phone: 218-249-6279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number82050
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: