Provider Demographics
NPI:1033505367
Name:WILLARD, SARAH J (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:J
Last Name:WILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:BIESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:217-344-9440
Mailing Address - Fax:217-344-4377
Practice Address - Street 1:1710 E WINDSOR RD
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-9564
Practice Address - Country:US
Practice Address - Phone:217-344-9440
Practice Address - Fax:217-344-4377
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59098208000000X
MO2018011078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ048873Medicaid