Healthcare Provider Details

I. General information

NPI: 1891081782
Provider Name (Legal Business Name): SARA GRIMES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18465 ORCHARD TRL
LAKEVILLE MN
55044-8885
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-0950
  • Fax:
Mailing address:
  • Phone: 612-262-9000
  • Fax: 908-788-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA09741900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number79377
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: