Provider Demographics
NPI:1760470777
Name:HENDRICKSON, MARGO (MD)
Entity Type:Individual
Prefix:
First Name:MARGO
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 770
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-733-8202
Mailing Address - Fax:
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:770
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2218
Practice Address - Country:US
Practice Address - Phone:702-733-8202
Practice Address - Fax:702-733-0265
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-160472086S0120X
NV71832086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF96453Medicare UPIN