Provider Demographics
NPI:1942354162
Name:MILFORD III, ALBERT F (DO)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:F
Last Name:MILFORD III
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6 BUTTERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-2148
Mailing Address - Country:US
Mailing Address - Phone:847-587-6112
Mailing Address - Fax:847-587-6113
Practice Address - Street 1:24 JOLIET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1705
Practice Address - Country:US
Practice Address - Phone:219-865-2141
Practice Address - Fax:219-864-2644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02000962A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054094Medicaid
IN100005230Medicaid
INC39498Medicare UPIN
IN10000523BMedicaid