Provider Demographics
NPI:1285826594
Name:MARGO HENDRICKSON MD INC
Entity Type:Organization
Organization Name:MARGO HENDRICKSON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-733-8202
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 770
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-733-8202
Mailing Address - Fax:702-733-0265
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:SUITE 770
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2218
Practice Address - Country:US
Practice Address - Phone:702-733-8202
Practice Address - Fax:702-733-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV71832086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty