# SARA M GOTHERIDGE MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295351062
- **Authorized official:** DR. SARA MARGARET GOTHERIDGE MD (PRESIDENT)
- **Authorized official phone:** (312) 640-7731

## Contact information

- **Practice address:** 630 DAVIS ST STE 301, EVANSTON, IL 60201-4480
- **Practice address phone:** (312) 640-7731
- **Practice address fax:** (877) 421-1846
- **Mailing address:** 2412 LAWNDALE AVE, EVANSTON, IL 60201-1854
- **Mailing address phone:** (312) 608-4996
- **Mailing address fax:** (877) 421-1846

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/17/2020
- **Last updated:** 06/17/2020