MEDICARE: SARAH HASEK, MD, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487833091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH HASEK, MD, LLC

Provider Business Mailing Address
First Line	:	207 W JACKSON ST STE 202
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-1408
Country	:	US
Telephone Number	:	618-351-9559
Fax Number	:	618-351-9005

Provider Business Practice Location Address
First Line	:	207 W JACKSON ST STE 202
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62901-1408
Country	:	US
Telephone Number	:	618-351-9559
Fax Number	:	618-351-9005

Authorized Official
Title or Position	:	MD
Name	:	SARAH BETH HASEK
Credential	:
Telephone Number	:	618-351-9559

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	03/13/2008

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