Healthcare Provider Details

I. General information

NPI: 1861138232
Provider Name (Legal Business Name): JORDAN GRACE MARGANSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E NORRIS DR
OTTAWA IL
61350-1604
US

IV. Provider business mailing address

1100 E NORRIS DR
OTTAWA IL
61350-1604
US

V. Phone/Fax

Practice location:
  • Phone: 815-433-3100
  • Fax: 815-433-0879
Mailing address:
  • Phone: 815-433-3100
  • Fax: 815-433-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125080388
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: