1598775975 NPI number — MARVIN H MARGOLIS MD SC

Table of content: (NPI 1598775975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598775975 NPI number — MARVIN H MARGOLIS MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARVIN H MARGOLIS MD SC
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:
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 Information

NPI Number:
1598775975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
929 FOUNTAIN VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-4860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-267-8282
Provider Business Mailing Address Fax Number:
847-267-8383

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010 S ARLINGTON HEIGHTS RD
Provider Second Line Business Practice Location Address:
STE. 219
Provider Business Practice Location Address City Name:
ARLINGTON HTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-267-8282
Provider Business Practice Location Address Fax Number:
847-267-8383
Provider Enumeration Date:
08/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARGOLIS
Authorized Official First Name:
MARVIN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
847-267-8282

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  042-002923 , 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)