Healthcare Provider Details

I. General information

NPI: 1023498730
Provider Name (Legal Business Name): MARGARET PARK MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N WABASH AVE UNIT 4403
CHICAGO IL
60611-3527
US

IV. Provider business mailing address

405 N WABASH AVE UNIT 4403
CHICAGO IL
60611-3527
US

V. Phone/Fax

Practice location:
  • Phone: 312-955-8787
  • Fax: 312-955-8789
Mailing address:
  • Phone: 312-955-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number036.113340
License Number StateIL

VIII. Authorized Official

Name: DR. MARGARET PARK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-343-4686