Basic Information
Provider Information | |||||||||
NPI: | 1982881710 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ETINGEN | ||||||||
FirstName: | MARGARITA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KARPMAN | ||||||||
OtherFirstName: | MARGARITA | ||||||||
OtherMiddleName: | LAZARCVNA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3880 SALEM LAKE DR | ||||||||
Address2: | STE F | ||||||||
City: | LONG GROVE | ||||||||
State: | IL | ||||||||
PostalCode: | 600475292 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8477192220 | ||||||||
FaxNumber: | 8477192265 | ||||||||
Practice Location | |||||||||
Address1: | 800 W CENTRAL RD | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON HEIGHTS | ||||||||
State: | IL | ||||||||
PostalCode: | 600052349 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8476185660 | ||||||||
FaxNumber: | 8476185669 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/23/2008 | ||||||||
LastUpdateDate: | 08/26/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-121009 | IL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 036-121009 | IL | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 336-082815 | 01 | IL | CONTROLLED SUBSTANCE | OTHER | FE0770378 | 01 |   | DEA | OTHER | 036-121009 | 01 | IL | PHYSICIAN LICENSE | OTHER |