Provider Demographics
NPI:1275630238
Name:GOTHERIDGE, SARA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:M
Last Name:GOTHERIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:625 N. MICHIGAN AVE
Mailing Address - Street 2:SUITE 2550
Mailing Address - City:CHGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-640-7728
Mailing Address - Fax:312-640-7736
Practice Address - Street 1:625 N. MICHIGAN AVE
Practice Address - Street 2:SUITE 2550
Practice Address - City:CHGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-640-7728
Practice Address - Fax:312-640-7736
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0361062852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry