Provider Demographics
NPI:1861551954
Name:BRAUNSTEIN, SARA (DO)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:BRAUNSTEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3012
Mailing Address - Country:US
Mailing Address - Phone:773-244-0441
Mailing Address - Fax:773-244-0906
Practice Address - Street 1:3002 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3012
Practice Address - Country:US
Practice Address - Phone:773-244-0441
Practice Address - Fax:773-244-0906
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36052112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4318794OtherAETNA
IL0360521124Medicaid
IL1632258OtherBLUE CROSS BLUE SHIELD
ILD12879Medicare UPIN
ILL91638Medicare ID - Type Unspecified