Provider Demographics
NPI:1396763421
Name:MARGOLIN, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:MARGOLIN
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 1:15545 W 87TH STREET PKWY
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1434
Mailing Address - Country:US
Mailing Address - Phone:913-894-4428
Mailing Address - Fax:
Practice Address - Street 1:15545 W 87TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1434
Practice Address - Country:US
Practice Address - Phone:913-894-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004005751208600000X
KS04-34103208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200309650AMedicaid
MO207330200Medicaid
MO207330200Medicaid
MOB94D358Medicare ID - Type Unspecified
MOH74D358Medicare ID - Type Unspecified
MOW19D358Medicare PIN