Provider Demographics
NPI:1952339764
Name:AYDT, SARAH A (MD, FAAP, FACP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:AYDT
Suffix:
Gender:F
Credentials:MD, FAAP, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-3000
Mailing Address - Fax:573-331-5073
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:STE 301
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-334-9641
Practice Address - Fax:573-331-4130
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5H60207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
174688OtherHEALTHLINK
MO603534OtherANTHEM BLUE SHIELD
MO202519302Medicaid
MO164685OtherHEALTH ALLIANCE
MOP00779911OtherRR MCR
IL1952339764Medicaid
MOP00779911OtherRR MCR
MO603534OtherANTHEM BLUE SHIELD