Provider Demographics
NPI:1366729378
Name:MUSCIA, MEGAN NELLIE (DO)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NELLIE
Last Name:MUSCIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 OGDEN AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7205
Mailing Address - Country:US
Mailing Address - Phone:630-375-2844
Mailing Address - Fax:630-375-2808
Practice Address - Street 1:2040 OGDEN AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7206
Practice Address - Country:US
Practice Address - Phone:630-375-2844
Practice Address - Fax:630-375-2808
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.130189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-130189Medicaid