Provider Demographics
NPI:1609038314
Name:MILLARE HEALTHCARE SC
Entity Type:Organization
Organization Name:MILLARE HEALTHCARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-524-1002
Mailing Address - Street 1:2500 W HIGGINS ROAD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7207
Mailing Address - Country:US
Mailing Address - Phone:847-524-1002
Mailing Address - Fax:847-524-1181
Practice Address - Street 1:2500 W HIGGINS ROAD
Practice Address - Street 2:SUITE 340
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7207
Practice Address - Country:US
Practice Address - Phone:847-524-1002
Practice Address - Fax:847-524-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046131208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15777Medicare UPIN