Provider Demographics
NPI:1801852926
Name:DAUPHIN-VAN DYK, MARGARET ISELY (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:ISELY
Last Name:DAUPHIN-VAN DYK
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 1:2738 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2043
Mailing Address - Country:US
Mailing Address - Phone:847-869-7159
Mailing Address - Fax:
Practice Address - Street 1:2800 N SHERIDAN RD STE 406
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6158
Practice Address - Country:US
Practice Address - Phone:312-201-0044
Practice Address - Fax:773-697-4628
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059705174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059705Medicaid
ILK25430Medicare PIN
IL036059705Medicaid