Provider Demographics
NPI:1558359869
Name:FREITAS, SARAH A (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:FREITAS
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 1:560 S MAPLE ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1733
Mailing Address - Country:US
Mailing Address - Phone:952-442-2137
Mailing Address - Fax:952-442-5960
Practice Address - Street 1:560 S MAPLE ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1733
Practice Address - Country:US
Practice Address - Phone:952-442-2137
Practice Address - Fax:952-442-5960
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN095467500Medicaid
MN095467500Medicaid
MNH63829Medicare UPIN