Provider Demographics
NPI:1619123114
Name:MICHELSON, MARGARET GROSS (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:GROSS
Last Name:MICHELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1000 CENTRAL ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1777
Mailing Address - Country:US
Mailing Address - Phone:847-570-2577
Mailing Address - Fax:847-733-5424
Practice Address - Street 1:1000 CENTRAL ST
Practice Address - Street 2:SUITE 800
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1777
Practice Address - Country:US
Practice Address - Phone:847-570-2577
Practice Address - Fax:847-733-5424
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125054703208000000X, 2084N0402X
IL0361311012084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics