Provider Demographics
NPI:1437100856
Name:MILORO, MICHAEL (DMD, MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MILORO
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7210
Mailing Address - Country:US
Mailing Address - Phone:312-996-1052
Mailing Address - Fax:312-996-5987
Practice Address - Street 1:801 S PAULINA ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7210
Practice Address - Country:US
Practice Address - Phone:312-996-1052
Practice Address - Fax:312-996-1052
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.119907204E00000X
IL019.027559204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557585Medicaid
ILF85881Medicare UPIN
NE273412Medicare ID - Type Unspecified
NE47078557585Medicaid