1164527503 NPI number — SARA J SHUMWAY MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164527503 NPI number — SARA J SHUMWAY MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SHUMWAY

Provider First Name:

SARA

Provider Middle Name:

J

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1164527503

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/07/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Second Line Business Mailing Address:

420 DELAWARE STREET SE, MMC 292

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55455

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-625-3600

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

PWB THIRD FLOOR, CLINIC 3B

Provider Second Line Business Practice Location Address:

516 DELAWARE STREET SE

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55455

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-625-3600

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

09/13/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  32237 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208G00000X , with the licence number: 32237 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 576390800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 18-22559 . This is a "MEDICA CHOICE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: HP22205 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1009309 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 18-70034 . This is a "MEDICA PRIMARY" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2T105SH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 0972356 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 101586 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 033969 . This is a "FAIRVIEW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 768349 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".