Provider Demographics
NPI:1356366454
Name:VILLALOBOS, MILAGROS (MD)
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:VILLALOBOS
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 1:3248 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-4939
Mailing Address - Country:US
Mailing Address - Phone:773-489-5440
Mailing Address - Fax:773-489-5460
Practice Address - Street 1:3248 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-4939
Practice Address - Country:US
Practice Address - Phone:773-489-5440
Practice Address - Fax:773-489-5460
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115882Medicaid
IL1636530OtherBLUE CROSS BLUE SHIELD
IL214242Medicare ID - Type UnspecifiedGROUP NUMBER