Provider Demographics
NPI:1629051958
Name:PARGULSKI, JOHN M (DO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:PARGULSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E MASON ST STE 4P57
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701-1034
Mailing Address - Country:US
Mailing Address - Phone:217-788-0706
Mailing Address - Fax:217-525-2535
Practice Address - Street 1:619 E MASON ST STE 4P57
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1034
Practice Address - Country:US
Practice Address - Phone:217-788-0706
Practice Address - Fax:217-525-2535
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3035207RC0000X
IA03035207RC0000X
IL036.145032207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014459OtherGROUP MISSOURI MEDICARE
IACD4547OtherRR GROUP NUMBER
IA0140798Medicaid
IA060040783OtherRAILROAD MEDICARE
IA1629051958Medicaid
IA54972Medicare ID - Type Unspecified
IA060040783OtherRAILROAD MEDICARE
IACD4547OtherRR GROUP NUMBER
IAG22176Medicare UPIN