Provider Demographics
NPI:1790841732
Name:VERGHESE, SARA (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:VERGHESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1516 WILLOWCREEK LANE
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561
Mailing Address - Country:US
Mailing Address - Phone:708-343-4620
Mailing Address - Fax:708-343-4632
Practice Address - Street 1:9902 WEST ROOSEVELT ROAD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2770
Practice Address - Country:US
Practice Address - Phone:708-343-4628
Practice Address - Fax:708-343-4632
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094498208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626666OtherBCBS PUR INSURANCE
IL036094498Medicaid
ILBV 5766146OtherDEA STATE
ILBV 5766146OtherDEA STATE