Provider Demographics
NPI:1023154945
Name:MEGGS, MARCIA (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:MEGGS
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 1:18221 TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2870
Mailing Address - Country:US
Mailing Address - Phone:708-895-9450
Mailing Address - Fax:708-895-9455
Practice Address - Street 1:18221 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2870
Practice Address - Country:US
Practice Address - Phone:708-895-9450
Practice Address - Fax:708-895-9455
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090798207L00000X
IN01043819A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090798Medicaid
IN000000603873OtherANTHEM PROVIDER NUMBER
IN200118920Medicaid
IN200118920Medicaid
INP00732697Medicare UPIN
ILB71740Medicare UPIN