Provider Demographics
NPI:1821450578
Name:SILAS, MEGAN ROSE (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROSE
Last Name:SILAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N JEFFERSON ST APT 1808
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1214
Mailing Address - Country:US
Mailing Address - Phone:847-609-6336
Mailing Address - Fax:
Practice Address - Street 1:5086 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2427
Practice Address - Country:US
Practice Address - Phone:773-282-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10813700207W00000X
IL036.155958207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty