Provider Demographics
NPI:1174733034
Name:SATHER, CARL A (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:SATHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-586-5093
Practice Address - Street 1:1001 HEATHER DR
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-2754
Practice Address - Country:US
Practice Address - Phone:217-586-8400
Practice Address - Fax:217-586-5093
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN1065152A207R00000X, 208000000X
IL036126717207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3270560Medicare PIN