Provider Demographics
NPI:1952388589
Name:FRIEDEWALD, SARAH MAIER (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MAIER
Last Name:FRIEDEWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:FIEDEWALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-695-5753
Mailing Address - Fax:312-695-5645
Practice Address - Street 1:250 E SUPERIOR ST
Practice Address - Street 2:NMH PRENTICE WOMEN'S HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2914
Practice Address - Country:US
Practice Address - Phone:312-695-5753
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361128792085R0202X
IN01030452A2085R0202X
WI485852085R0202X
PAMD4215592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112879Medicaid
ILI01956Medicare UPIN
ILK16769Medicare PIN
ILK16768Medicare PIN
ILK22461Medicare PIN
ILK28476Medicare PIN
ILK16770Medicare PIN
IL036112879Medicaid
ILP00261830Medicare PIN
ILP00422731Medicare PIN
ILP00355080Medicare PIN