Provider Demographics
NPI:1649495144
Name:COCOMA, SARAH MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARIE
Last Name:COCOMA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:JELKE 7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-1738
Mailing Address - Fax:312-942-8858
Practice Address - Street 1:1653 W CONGRESS PKWY
Practice Address - Street 2:JELKE 7
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3833
Practice Address - Country:US
Practice Address - Phone:312-942-1738
Practice Address - Fax:312-942-8858
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036122939207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL646410005Medicare PIN