Provider Demographics
NPI:1164527503
Name:SHUMWAY, SARA J (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 292
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-3600
Mailing Address - Fax:
Practice Address - Street 1:PWB THIRD FLOOR, CLINIC 3B
Practice Address - Street 2:516 DELAWARE STREET SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-625-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32237208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN576390800Medicaid
MN18-22559OtherMEDICA CHOICE
MNHP22205OtherHEALTH PARTNERS
MN1009309OtherPREFERRED ONE
MN18-70034OtherMEDICA PRIMARY
MN2T105SHOtherBLUE CROSS BLUE SHIELD
IA0972356Medicaid
MN101586OtherUCARE
MN033969OtherFAIRVIEW
MN768349OtherARAZ
MN18-22559OtherMEDICA CHOICE
MN2T105SHOtherBLUE CROSS BLUE SHIELD