Provider Demographics
NPI:1477607414
Name:PURAY, MILAGROS (MD)
Entity Type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:
Last Name:PURAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MILAGROS
Other - Middle Name:
Other - Last Name:DILOYPURAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1835 DIXIE HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1989
Mailing Address - Country:US
Mailing Address - Phone:708-799-0990
Mailing Address - Fax:708-799-0991
Practice Address - Street 1:1835 DIXIE HWY STE 104
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1989
Practice Address - Country:US
Practice Address - Phone:708-799-0990
Practice Address - Fax:708-799-0991
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12504Medicare UPIN
IL468620Medicare PIN
IL036046882Medicare ID - Type Unspecified