Provider Demographics
NPI:1508445487
Name:KULLBERG PEARSON, SARA ANN (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ANN
Last Name:KULLBERG PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:KULLBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2997
Mailing Address - Country:US
Mailing Address - Phone:312-695-8106
Mailing Address - Fax:312-695-0664
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2997
Practice Address - Country:US
Practice Address - Phone:312-695-8106
Practice Address - Fax:312-695-0664
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125085121207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program