1982881710 NPI number — MARGARITA ETINGEN MD

Table of content: MARGARITA ETINGEN MD (NPI 1982881710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982881710 NPI number — MARGARITA ETINGEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ETINGEN
Provider First Name:
MARGARITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARPMAN
Provider Other First Name:
MARGARITA
Provider Other Middle Name:
LAZARCVNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982881710
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3880 SALEM LAKE DR
Provider Second Line Business Mailing Address:
STE F
Provider Business Mailing Address City Name:
LONG GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60047-5292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-719-2220
Provider Business Mailing Address Fax Number:
847-719-2265

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W CENTRAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-2349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-618-5660
Provider Business Practice Location Address Fax Number:
847-618-5669
Provider Enumeration Date:
01/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036-121009 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: 036-121009 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 336-082815 . This is a "CONTROLLED SUBSTANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036-121009 . This is a "PHYSICIAN LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".