Provider Demographics
NPI:1497884712
Name:MARESKY, MARGOT (PT)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:MARESKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:847-573-8990
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:847-573-8990
Practice Address - Fax:847-573-8082
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005038174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632056OtherBLUE SHIELD PROVIDER NUM