Healthcare Provider Details

I. General information

NPI: 1346261146
Provider Name (Legal Business Name): TERESA M MARGANSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E ORANGE ST
HOOPESTON IL
60942-1802
US

IV. Provider business mailing address

611 W PARK ST BWPC
URBANA IL
61801-2529
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-5644
  • Fax: 217-283-7432
Mailing address:
  • Phone: 217-383-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036072106
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: