Provider Demographics
NPI:1639271034
Name:MARGALLO, LUCIO N II (MD)
Entity Type:Individual
Prefix:MR
First Name:LUCIO
Middle Name:N
Last Name:MARGALLO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2917
Mailing Address - Country:US
Mailing Address - Phone:605-996-5553
Mailing Address - Fax:605-996-1213
Practice Address - Street 1:1115 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2917
Practice Address - Country:US
Practice Address - Phone:605-996-5553
Practice Address - Fax:605-996-1213
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6000720Medicaid
460273800OtherTAX ID
4602738000000EOtherCOMMERCIAL NUMBER ON COMP
4602738000000EOtherCOMMERCIAL NUMBER ON COMP
SD6000720Medicaid
SDS1639Medicare PIN