MEDICARE: DR. SARAH PRUSS DVM

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	174M00000X	Veterinarian	090.010565	IL

General Provider Information

NPI Number	:	1720467335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH PRUSS DVM

Provider Business Mailing Address
First Line	:	2079 LINCOLN HWY
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-1580
Country	:	US
Telephone Number	:	630-443-1472
Fax Number	:

Provider Business Practice Location Address
First Line	:	2079 LINCOLN HWY
Second Line	:
City	:	ST CHARLES
State	:	IL
Zip	:	60174-1580
Country	:	US
Telephone Number	:	630-443-1472
Fax Number	:

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

Provider Enumeration Date	:	05/28/2015
Last Update Date	:	05/28/2015

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