Provider Demographics
NPI:1003808411
Name:MILAS, ROBERT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:MILAS
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 1:4333 18TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-3907
Mailing Address - Country:US
Mailing Address - Phone:309-786-2010
Mailing Address - Fax:309-786-2003
Practice Address - Street 1:4333 18TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-3907
Practice Address - Country:US
Practice Address - Phone:309-786-2010
Practice Address - Fax:309-786-2003
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043424207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043424Medicaid
IA0949669Medicaid
ILD09794Medicare UPIN
IA0949669Medicaid