1700173226 NPI number — MARGARITA G VALDECANTOS MD

Table of content: MARGARITA G VALDECANTOS MD (NPI 1700173226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700173226 NPI number — MARGARITA G VALDECANTOS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VALDECANTOS
Provider First Name:
MARGARITA
Provider Middle Name:
G
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:
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:
1700173226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5999 NEW WILKE RD BLDG 2
Provider Second Line Business Mailing Address:
SUITE 200 BUILDING 2
Provider Business Mailing Address City Name:
ROLLING MEADOWS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60008-4506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-255-7107
Provider Business Mailing Address Fax Number:
847-255-7031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5999 NEW WILKE RD
Provider Second Line Business Practice Location Address:
SUITE 200 BUILDING 2
Provider Business Practice Location Address City Name:
ROLLING MEADOWS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60008-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-255-7107
Provider Business Practice Location Address Fax Number:
847-255-7031
Provider Enumeration Date:
07/05/2011

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: 207Q00000X , with the licence number:  036135001 , 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: 036135001 . This is a "STATE LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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