Provider Demographics
NPI:1598784209
Name:DEVAULT, MARGARET M (PA-C)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:DEVAULT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LIONS DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3182
Mailing Address - Country:US
Mailing Address - Phone:847-304-0044
Mailing Address - Fax:847-304-5885
Practice Address - Street 1:111 LIONS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3182
Practice Address - Country:US
Practice Address - Phone:847-304-0044
Practice Address - Fax:847-304-5885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085002135363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical