1376769463 NPI number — MARGOT MARESKY PC

Table of content: DR. CAROL TANASE D.D.S. (NPI 1558577080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376769463 NPI number — MARGOT MARESKY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARGOT MARESKY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KIDZ PT INC
Provider Other Organization Name Type Code:
3
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 Information

NPI Number:
1376769463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1673 N WOODS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERNON HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60061-1237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-573-8992
Provider Business Mailing Address Fax Number:
847-573-8082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1673 N WOODS WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60061-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-573-8992
Provider Business Practice Location Address Fax Number:
847-573-8082
Provider Enumeration Date:
04/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICHTER
Authorized Official First Name:
KARIN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING SERVICE
Authorized Official Telephone Number:
847-769-5316

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  070005038 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01632056 . This is a "BLUE SHIELD PROVIDER NUM" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 341767342001 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".