Provider Demographics
NPI:1255341632
Name:MARGOLIS, MARVIN HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:HARVEY
Last Name:MARGOLIS
Suffix:
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 1:2010 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:STE. 219
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4134
Mailing Address - Country:US
Mailing Address - Phone:847-437-0620
Mailing Address - Fax:847-437-0621
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:STE. 219
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4134
Practice Address - Country:US
Practice Address - Phone:847-437-0620
Practice Address - Fax:847-437-0621
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-45469207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021602682OtherBCBSIL
ILK44198Medicare PIN