Provider Demographics
NPI:1154566396
Name:WHITTAKER, SARAH PHELPS (DPM)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:PHELPS
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 FORD PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3412
Mailing Address - Country:US
Mailing Address - Phone:651-698-8879
Mailing Address - Fax:651-698-7243
Practice Address - Street 1:2221 FORD PARKWAY
Practice Address - Street 2:SUITE #350
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3837
Practice Address - Country:US
Practice Address - Phone:651-698-8879
Practice Address - Fax:651-698-7243
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI969-025213E00000X
MN830213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0732240001OtherDMERC W/ PREFERRED PODIATRY GROUP
WI1154566396Medicaid
WI814350017Medicare PIN
WI1154566396Medicaid
WI865500017Medicare PIN
WI864810022Medicare PIN
P00798191Medicare PIN
WI864860019Medicare PIN
0732240001OtherDMERC W/ PREFERRED PODIATRY GROUP