Healthcare Provider Details

I. General information

NPI: 1265231450
Provider Name (Legal Business Name): SARAH TIBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

IV. Provider business mailing address

3333 GREEN BAY RD
NORTH CHICAGO IL
60064-3037
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-6112
  • Fax:
Mailing address:
  • Phone: 847-578-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.260921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: