Provider Demographics
NPI:1578083929
Name:GHEVARIYA, SARA (DO)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:GHEVARIYA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:DANHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:10260 191ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8802
Mailing Address - Country:US
Mailing Address - Phone:708-425-1907
Mailing Address - Fax:708-422-4358
Practice Address - Street 1:9730 S WESTERN AVE STE 700
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2814
Practice Address - Country:US
Practice Address - Phone:708-425-1907
Practice Address - Fax:708-422-4358
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036156735207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY39020000XMedicaid