Provider Demographics
NPI:1710966213
Name:MILLARE, EDUARDO A (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:A
Last Name:MILLARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 36TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6631
Mailing Address - Country:US
Mailing Address - Phone:309-787-2767
Mailing Address - Fax:262-997-2761
Practice Address - Street 1:5317 36TH AVENUE CT
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6631
Practice Address - Country:US
Practice Address - Phone:309-787-2767
Practice Address - Fax:262-997-2761
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09799Medicare UPIN