Provider Demographics
NPI:1598775975
Name:MARVIN H MARGOLIS MD SC
Entity Type:Organization
Organization Name:MARVIN H MARGOLIS MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-267-8282
Mailing Address - Street 1:929 FOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4860
Mailing Address - Country:US
Mailing Address - Phone:847-267-8282
Mailing Address - Fax:847-267-8383
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:STE. 219
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4134
Practice Address - Country:US
Practice Address - Phone:847-267-8282
Practice Address - Fax:847-267-8383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-002923207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL463670Medicare PIN