Provider Demographics
NPI:1689854804
Name:JOHNSON, SARA (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JOHNSON
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 1:3033 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4688
Mailing Address - Country:US
Mailing Address - Phone:612-827-4751
Mailing Address - Fax:612-827-7768
Practice Address - Street 1:3033 EXCELSIOR BLVD
Practice Address - Street 2:SUITE 275
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4688
Practice Address - Country:US
Practice Address - Phone:612-827-4751
Practice Address - Fax:612-827-7768
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine