Provider Demographics
NPI:1376769463
Name:MARGOT MARESKY PC
Entity Type:Organization
Organization Name:MARGOT MARESKY PC
Other - Org Name:KIDZ PT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-769-5316
Mailing Address - Street 1:1673 N WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1237
Mailing Address - Country:US
Mailing Address - Phone:847-573-8992
Mailing Address - Fax:847-573-8082
Practice Address - Street 1:1673 N WOODS WAY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1237
Practice Address - Country:US
Practice Address - Phone:847-573-8992
Practice Address - Fax:847-573-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005038174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632056OtherBLUE SHIELD PROVIDER NUM
IL341767342001Medicaid