Provider Demographics
NPI:1053383653
Name:MARGOLIS, DAVID ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ISAAC
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2050 N HAGGERTY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3795
Mailing Address - Country:US
Mailing Address - Phone:734-981-1086
Mailing Address - Fax:734-981-5094
Practice Address - Street 1:2050 N HAGGERTY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3795
Practice Address - Country:US
Practice Address - Phone:734-981-1086
Practice Address - Fax:734-981-5094
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301063642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110227239OtherRAILROAD MEDICARE
MI104365378Medicaid
MI104365378Medicaid
110227239OtherRAILROAD MEDICARE