MEDICARE: DR. SARAH R FLORENCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	036131999	IL

General Provider Information

NPI Number	:	1225359870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH R FLORENCE M.D.

Provider Business Mailing Address
First Line	:	2539 N KEDZIE BLVD STE 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1435
Country	:	US
Telephone Number	:	773-609-3691
Fax Number	:	866-364-6767

Provider Business Practice Location Address
First Line	:	2539 N KEDZIE BLVD STE 4
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1435
Country	:	US
Telephone Number	:	773-609-3691
Fax Number	:	866-364-6767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	01/17/2023

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