MEDICARE: SARA ENID TISHERMAN MD

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	207Q00000X	Family Medicine Physician	MD478338	PA
2	207Q00000X	Family Medicine Physician	35.148505	OH
3	207Q00000X	Family Medicine Physician	DR.0075904	CO

General Provider Information

NPI Number	:	1477015063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA ENID TISHERMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 110429
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80042-0429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8959 E 40TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80238-5026
Country	:	US
Telephone Number	:	720-462-2263
Fax Number	:	303-845-9656

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	09/26/2025

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