Provider Demographics
NPI:1225088693
Name:MIYARES, FRANCISCO J (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:J
Last Name:MIYARES
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 1:213 N RACINE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1644
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:301 E. STATE ST.
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104
Practice Address - Country:US
Practice Address - Phone:815-668-7810
Practice Address - Fax:815-714-6219
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085264207R00000X
WI39514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400218933OtherMEDICARE PTAN
IL036085264Medicaid
ILP00196872OtherRR METRAHEALTH SOUTH IL
ILP00242646OtherMETRAHEALTH RR NORTH IL
IL036085264Medicaid
ILK13092Medicare ID - Type UnspecifiedSOUTH ILLINOIS