Provider Demographics
NPI:1801587472
Name:GEBREMRAIAM, SARA G
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:G
Last Name:GEBREMRAIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8589 W APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4226
Mailing Address - Country:US
Mailing Address - Phone:414-241-2887
Mailing Address - Fax:
Practice Address - Street 1:8589 W APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4226
Practice Address - Country:US
Practice Address - Phone:414-241-2887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver