MEDICARE: MR. IRWIN MARGOLIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	17519	WI
2	207RX0202X	Medical Oncology Physician	17519	WI

General Provider Information

NPI Number	:	1538418322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRWIN MARGOLIS M.D.

Provider Business Mailing Address
First Line	:	2635 WEST LAKE PARK COURT
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-2453
Country	:	US
Telephone Number	:	262-643-4097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 WEST LAKE PARK COURT
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-2453
Country	:	US
Telephone Number	:	262-643-4097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	09/07/2012

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