Provider Demographics
NPI:1093164055
Name:URTON, SARAH ADA GENEVIEVE (DPM)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ADA GENEVIEVE
Last Name:URTON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 N CLARK ST
Mailing Address - Street 2:APT 310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3847
Mailing Address - Country:US
Mailing Address - Phone:510-704-3167
Mailing Address - Fax:
Practice Address - Street 1:2900 N. LAKE SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6274
Practice Address - Country:US
Practice Address - Phone:773-665-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2017-02-10
Deactivation Date:2017-01-25
Deactivation Code:
Reactivation Date:2017-02-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
113-560-477OtherUSCIC #