Provider Demographics
NPI:1659330025
Name:FERNANDES, MILAGRES MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MILAGRES
Middle Name:MARTIN
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:MARTIN
Other - Last Name:FERNANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-358-5555
Mailing Address - Fax:440-258-5556
Practice Address - Street 1:7500 AUBURN RD # 2300
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9176
Practice Address - Country:US
Practice Address - Phone:440-358-5555
Practice Address - Fax:440-358-5556
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-043299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH264168OtherFEDERAL BLACK LUNG
OH0403790Medicaid
OH264168OtherFEDERAL BLACK LUNG