Provider Demographics
NPI:1578772570
Name:EMMANUEL, MILROY S (MD)
Entity Type:Individual
Prefix:DR
First Name:MILROY
Middle Name:S
Last Name:EMMANUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MILROY
Other - Middle Name:S
Other - Last Name:EMMANUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4955 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2286
Mailing Address - Country:US
Mailing Address - Phone:773-736-3770
Mailing Address - Fax:773-736-1403
Practice Address - Street 1:4955 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2286
Practice Address - Country:US
Practice Address - Phone:773-736-3770
Practice Address - Fax:773-736-1403
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42461Medicare UPIN