Provider Demographics
NPI:1215467154
Name:TATE, MARGARET LOUISA (DO)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:LOUISA
Last Name:TATE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2512 HURST DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-9200
Mailing Address - Country:US
Mailing Address - Phone:217-258-5900
Mailing Address - Fax:217-258-3686
Practice Address - Street 1:2512 HURST DR STE 120
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9200
Practice Address - Country:US
Practice Address - Phone:217-258-5900
Practice Address - Fax:217-258-3686
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125070285207Q00000X
IL036150937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine