1033243506 NPI number — MARGARET T SMITH GAUTHIER P.T.

Table of content: MARGARET T SMITH GAUTHIER P.T. (NPI 1033243506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033243506 NPI number — MARGARET T SMITH GAUTHIER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAUTHIER
Provider First Name:
MARGARET
Provider Middle Name:
T SMITH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
MARGARET
Provider Other Middle Name:
THERESE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033243506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 N 73RD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMWOOD PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60707-2039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-238-3114
Provider Business Mailing Address Fax Number:
312-238-2130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 W WILSON AVE
Provider Second Line Business Practice Location Address:
SU. 100
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60640-5255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-238-3114
Provider Business Practice Location Address Fax Number:
312-238-3130
Provider Enumeration Date:
03/15/2007

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: 225100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2251N0400X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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