Healthcare Provider Details

I. General information

NPI: 1639480650
Provider Name (Legal Business Name): SARA S MCCOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 UPLAND TRL
MIDDLETON WI
53562-5221
US

IV. Provider business mailing address

5502 UPLAND TRL
MIDDLETON WI
53562-5221
US

V. Phone/Fax

Practice location:
  • Phone: 585-704-3972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number64312
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301102157
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54191
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: