Provider Demographics
NPI:1275638215
Name:SIERANTOWICZ, MARGARET MARIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARIA
Last Name:SIERANTOWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 EXECUTIVE CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9531
Mailing Address - Country:US
Mailing Address - Phone:847-620-7969
Mailing Address - Fax:847-620-7977
Practice Address - Street 1:8 EXECUTIVE CT
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9531
Practice Address - Country:US
Practice Address - Phone:847-620-7969
Practice Address - Fax:847-620-7977
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05700736Medicaid