Provider Demographics
NPI:1134152937
Name:MARGULIS, VITALY (MD)
Entity type:Individual
Prefix:DR
First Name:VITALY
Middle Name:
Last Name:MARGULIS
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9110
Mailing Address - Country:US
Mailing Address - Phone:214-648-0567
Mailing Address - Fax:214-648-8786
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9110
Practice Address - Country:US
Practice Address - Phone:214-648-0567
Practice Address - Fax:214-648-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5034208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology