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General NPI Number Information
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NPI Number | 1093164055
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Entity Type | Individual
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Provider Name | SARAH ADA GENEVIEVE URTON DPM
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Gender | Female
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Dates
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Enumeration Date | 06/09/2016
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Last Update Date | 02/10/2017
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Provider Practice Location Address
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Address Line | 2900 N. LAKE SHORE DRIVE
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City | CHICAGO
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State | IL
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Zip | 60657-6274
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Country | US
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Telephone | 773-665-6730
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 N CLARK ST APT 310
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City | CHICAGO
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State | IL
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Zip | 60614-3847
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Country | US
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Telephone | 510-704-3167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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