Provider Demographics
NPI:1720377922
Name:MULYE, MILAN DIWAKAR (MD)
Entity Type:Individual
Prefix:
First Name:MILAN
Middle Name:DIWAKAR
Last Name:MULYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MILAN
Other - Middle Name:D
Other - Last Name:MULYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5841 S MARYLAND AVE # MC6082
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1443
Mailing Address - Country:US
Mailing Address - Phone:773-834-0497
Mailing Address - Fax:773-834-5964
Practice Address - Street 1:19550 GOVERNORS HWY STE 2500
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2145
Practice Address - Country:US
Practice Address - Phone:708-799-7600
Practice Address - Fax:708-799-8848
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60548135208000000X
IL036.134888208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics