Healthcare Provider Details

I. General information

NPI: 1962900191
Provider Name (Legal Business Name): MARGARET PARK MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N WABASH AVE UNIT 1412
CHICAGO IL
60611-5658
US

IV. Provider business mailing address

405 N WABASH AVE UNIT 1412
CHICAGO IL
60611-5658
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MARGARET PARK
Title or Position: PRESIDENT
Credential: MD
Phone: 312-955-8787