Provider Demographics
NPI:1013028307
Name:SPAR, MYLES D (MD)
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:D
Last Name:SPAR
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:DEPT CH 19338
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-0783
Mailing Address - Country:US
Mailing Address - Phone:212-880-5494
Mailing Address - Fax:
Practice Address - Street 1:133 E 58TH ST STE 512
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1145
Practice Address - Country:US
Practice Address - Phone:212-880-5494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG81948DMedicare ID - Type Unspecified
CAWG81948EMedicare ID - Type Unspecified
CAWG81948BMedicare ID - Type Unspecified
CAWG81948CMedicare ID - Type Unspecified