Provider Demographics
NPI:1659345684
Name:SAUEREISEN, SANDRA CHASE (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:CHASE
Last Name:SAUEREISEN
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 1:4115 BRIDGE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3304
Mailing Address - Country:US
Mailing Address - Phone:216-281-8072
Mailing Address - Fax:
Practice Address - Street 1:11906 MADISON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44107-5027
Practice Address - Country:US
Practice Address - Phone:216-281-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054479L207Q00000X
OH35.142506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472435Medicaid
PA716749Medicare ID - Type Unspecified