Provider Demographics
NPI:1558624171
Name:TILLMAN, SARAH KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHLEEN
Last Name:TILLMAN
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 1:9201 W BROADWAY AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1924
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7066
Practice Address - Street 1:5109 36TH AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2007
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7989
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34960207V00000X
MN61220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology