Provider Demographics
NPI:1922319656
Name:CROSARA, SANDRA LETICIA REIS (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA LETICIA
Middle Name:REIS
Last Name:CROSARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA LETICIA
Other - Middle Name:
Other - Last Name:REIS CROSARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:641-428-3059
Practice Address - Street 1:1000 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-428-6999
Practice Address - Fax:641-428-6678
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR9307207R00000X
IAMD42153207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine