Provider Demographics
NPI:1770560849
Name:MARGOLIS, ELIEZER TZVI (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:TZVI
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 MADISON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2203
Mailing Address - Country:US
Mailing Address - Phone:847-869-6236
Mailing Address - Fax:
Practice Address - Street 1:621 MADISON ST
Practice Address - Street 2:SUITE C
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2203
Practice Address - Country:US
Practice Address - Phone:847-869-6236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X, 103G00000X, 103TR0400X, 103TH0100X, 106H00000X, 103T00000X, 103TA0700X, 103TC1900X, 103TF0000X, 103TF0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL985470Medicare ID - Type Unspecified
ILR19467Medicare UPIN