Provider Demographics
NPI:1396754735
Name:PARK, MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N WABASH AVE UNIT 4403
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3527
Mailing Address - Country:US
Mailing Address - Phone:312-955-8787
Mailing Address - Fax:312-955-8789
Practice Address - Street 1:405 N WABASH AVE UNIT 4403
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3527
Practice Address - Country:US
Practice Address - Phone:312-955-8787
Practice Address - Fax:312-275-8787
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1133402084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI60389Medicare UPIN