Provider Demographics
NPI:1174600514
Name:MARGOLIS, BENJAMIN D (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:D
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 WAUKEGAN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1857
Mailing Address - Country:US
Mailing Address - Phone:847-236-1300
Mailing Address - Fax:
Practice Address - Street 1:2151 WAUKEGAN RD STE 110
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1857
Practice Address - Country:US
Practice Address - Phone:847-236-1300
Practice Address - Fax:847-236-9637
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074044207RS0012X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360740442Medicaid
IL943410Medicare PIN
ILE19075Medicare UPIN
ILK46660Medicare PIN