Provider Demographics
NPI:1700329299
Name:MAGULAK, MEREDITH JULIA (APN)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:JULIA
Last Name:MAGULAK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 W ARMITAGE AVE
Mailing Address - Street 2:APT 2RW
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1069
Mailing Address - Country:US
Mailing Address - Phone:248-520-5221
Mailing Address - Fax:
Practice Address - Street 1:3229 W 47TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-3011
Practice Address - Country:US
Practice Address - Phone:773-254-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015200363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics