Healthcare Provider Details

I. General information

NPI: 1609995893
Provider Name (Legal Business Name): SARA NORTHWAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA WISNIEWSKI

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2371850
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: