MEDICARE: DR. ULYSSES M MAGNANAO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036105671	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01117452	OTHER	IL	RAILROAD MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	612034800	OTHER	IL	IL DEPT OF LABOR
3	05632168	OTHER	IL	BLUE CROSS & BLUE SHIELD
5	05632414	OTHER	IL	BCBS PROV #
6	1619414	OTHER	IL	BCBS GROUP

General Provider Information

NPI Number	:	1225020142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ULYSSES M MAGNANAO D.O.

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 N RANDALL RD
Second Line	:	SUITE 200
City	:	ELGIN
State	:	IL
Zip	:	60123-9400
Country	:	US
Telephone Number	:	847-214-5780
Fax Number	:	847-214-5777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/06/2025

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Directions to “ DR. ULYSSES M MAGNANAO D.O.” Practice Location

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