Provider Demographics
NPI:1962900191
Name:MARGARET PARK MD SC
Entity type:Organization
Organization Name:MARGARET PARK MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-955-8787
Mailing Address - Street 1:405 N WABASH AVE UNIT 1412
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5658
Mailing Address - Country:US
Mailing Address - Phone:312-955-8787
Mailing Address - Fax:
Practice Address - Street 1:405 N WABASH AVE UNIT 1412
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5658
Practice Address - Country:US
Practice Address - Phone:312-955-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARGARET PARK MD SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies