Provider Demographics
NPI:1578618286
Name:KEILER, SARA JESSICA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:JESSICA
Last Name:KEILER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:JESSICA
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2740 W FOSTER AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3591
Mailing Address - Country:US
Mailing Address - Phone:773-907-3400
Mailing Address - Fax:773-907-0341
Practice Address - Street 1:2740 W FOSTER AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3591
Practice Address - Country:US
Practice Address - Phone:773-907-3400
Practice Address - Fax:773-907-0341
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95566207R00000X
IN01079261A207RI0200X
OH35099974207RI0200X
IL036.144659207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103068Medicaid
OHH306640Medicare PIN
OH0103068Medicaid