Provider Demographics
NPI:1770613630
Name:CONWAY, SARAH K (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:K
Last Name:CONWAY
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 1:767 E ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045
Mailing Address - Country:US
Mailing Address - Phone:847-212-0224
Mailing Address - Fax:
Practice Address - Street 1:450 WEST HIGHWAY 22
Practice Address - Street 2:GOOD SHEPHERD HOSPITAL
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-842-4191
Practice Address - Fax:847-842-4804
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211657OtherMEDICARE GROUP NUMBER
ILK19281Medicare PIN
ILG18168Medicare UPIN