MEDICARE: KENNETH R MARGULES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	036056714	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4900946	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1063403145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH R MARGULES MD

Provider Business Mailing Address
First Line	:	755 S MILWAUKEE AVE
Second Line	:	SUITE 250
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3253
Country	:	US
Telephone Number	:	847-367-0072
Fax Number	:	847-367-0876

Provider Business Practice Location Address
First Line	:	755 S MILWAUKEE AVE
Second Line	:	SUITE 250
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3253
Country	:	US
Telephone Number	:	847-367-0072
Fax Number	:	847-367-0876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	03/07/2023

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Directions to “ KENNETH R MARGULES MD” Practice Location

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