Healthcare Provider Details

I. General information

NPI: 1457093312
Provider Name (Legal Business Name): MARGO GRONAUER SAHAROVICI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9860 GOODMAN RD
OLIVE BRANCH MS
38654-1722
US

IV. Provider business mailing address

765 VALLEYBROOK DR
MEMPHIS TN
38120-2746
US

V. Phone/Fax

Practice location:
  • Phone: 662-890-0158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35110
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number74168
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: