Provider Demographics
NPI:1922174085
Name:PENKALA, MARGARET MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MICHELE
Last Name:PENKALA
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 1:251 TURN PIKE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8098
Mailing Address - Country:US
Mailing Address - Phone:916-985-9300
Mailing Address - Fax:916-355-1209
Practice Address - Street 1:251 TURN PIKE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8098
Practice Address - Country:US
Practice Address - Phone:916-985-9300
Practice Address - Fax:916-355-1209
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75202207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0068231Medicaid
CAGR0068233Medicaid
CA00G752020Medicaid
CAGR0068230Medicaid
CAGR006823BMedicaid
CAZZZ47675ZOtherBLUE SHIELD
CAZZZ47676ZOtherBLUE SHIELD
CA060040266OtherRAILROAD MEDICARE
CAZZZ47673ZOtherBLUE SHIELD
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068232Medicaid
CAGR0068235Medicaid
CAZZZ00965ZMedicare PIN
CA060040266OtherRAILROAD MEDICARE
CAGR0068233Medicaid
CAGR0068235Medicaid
CAZZZ47676ZOtherBLUE SHIELD
CAZZZ62306ZOtherBLUE SHIELD
CAGR0068235Medicaid
CAGR0068233Medicaid