Healthcare Provider Details
I. General information
NPI: 1124391073
Provider Name (Legal Business Name): MARGARET M GARSTKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 02/22/2012
Last Update Date: 07/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
11900 SOUTHWEST HWY
PALOS PARK IL
60464-1200
US
IV. Provider business mailing address
700 E OGDEN AVE SUITE 304
WESTMONT IL
60559-1398
US
V. Phone/Fax
- Phone: 708-274-4900
- Fax: 708-274-4949
- Phone: 866-871-5737
- Fax: 630-522-0843
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363AM0700X |
| Taxonomy | Medical Physician Assistant |
| License Number | 085000970 |
| License Number State | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: