Provider Demographics
NPI:1447521109
Name:MARGULES, DEBORAH CLARE (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CLARE
Last Name:MARGULES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:MARGULES
Other - Last Name:ELDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 MEDICAL PARK DR SE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3610
Mailing Address - Country:US
Mailing Address - Phone:616-214-8944
Mailing Address - Fax:616-214-8942
Practice Address - Street 1:1001 MEDICAL PARK DR SE
Practice Address - Street 2:SUITE 112
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3610
Practice Address - Country:US
Practice Address - Phone:616-214-8944
Practice Address - Fax:616-214-8942
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056138207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF81496Medicare UPIN