Provider Demographics
NPI:1780671560
Name:OCONNELL, SARA S (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:S
Last Name:OCONNELL
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:PO BOX 803861
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-3861
Mailing Address - Country:US
Mailing Address - Phone:913-341-3100
Mailing Address - Fax:913-341-6818
Practice Address - Street 1:7504 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2622
Practice Address - Country:US
Practice Address - Phone:913-341-3100
Practice Address - Fax:913-341-6818
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24072174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
180013311OtherRAILROAD MEDICARE
A67488Medicare UPIN
KS2253195Medicare ID - Type Unspecified