Provider Demographics
NPI:1225042716
Name:ROLOFF, SARA K (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:K
Last Name:ROLOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:K
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1218 W KILBOURN AVE STE 511
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1325
Mailing Address - Country:US
Mailing Address - Phone:414-469-4536
Mailing Address - Fax:
Practice Address - Street 1:1218 W KILBOURN AVE STE 511
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1325
Practice Address - Country:US
Practice Address - Phone:414-469-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2004-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI019550010Medicare PIN