Provider Demographics
NPI:1861138232
Name:MARGANSKI, JORDAN GRACE (MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:GRACE
Last Name:MARGANSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1604
Mailing Address - Country:US
Mailing Address - Phone:815-433-3100
Mailing Address - Fax:815-433-0879
Practice Address - Street 1:1100 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-1604
Practice Address - Country:US
Practice Address - Phone:815-433-3100
Practice Address - Fax:815-433-0879
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125080388207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine