Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 019.027559 | IL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 036.119907 | IL |
NPI | 1437100856 |
---|---|
Provider Name | Michael Miloro |
First Address | Chicago, IL 60612-7210 |
Second Address | Chicago, IL 60612-7210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 17/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47078557585 | (05) | NE |
F85881 | (02) | IL |
F85881 | (02) | NE |