Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 036056714 | IL |
NPI | 1063403145 |
---|---|
Provider Name | Kenneth R Margules |
First Address | Libertyville, IL 60048-3253 |
Second Address | Libertyville, IL 60048-3253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2005 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036056714 | (05) | IL |
4900946 | BCBS (01) | IL |
BM3436537 | DEA (01) | IL |
C45412 | (02) |