Provider Demographics
NPI:1528162062
Name:MARGOLIN, RICHARD ALLEN (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:MARGOLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE GRN STE 120
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3095
Practice Address - Country:US
Practice Address - Phone:847-390-5500
Practice Address - Fax:847-390-5501
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103435Medicaid
IL036103435Medicaid
IL202902Medicare ID - Type Unspecified