Provider Demographics
NPI:1851337026
Name:GARRETSON, SANDRA H (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:H
Last Name:GARRETSON
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 1:405 LAKE ZURICH RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3141
Mailing Address - Country:US
Mailing Address - Phone:847-381-5599
Mailing Address - Fax:847-381-1431
Practice Address - Street 1:405 LAKE ZURICH RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3141
Practice Address - Country:US
Practice Address - Phone:847-381-5599
Practice Address - Fax:847-381-1431
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073462207RH0002X
IL036-073462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-073462OtherLICENSE #
IL110227220OtherRAILROAD MEDICARE
ILL88004OtherMEDICARE LEGACY
IL110227220OtherRAILROAD MEDICARE