Healthcare Provider Details

I. General information

NPI: 1316336167
Provider Name (Legal Business Name): ANTHONY MILLARD II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S WACKER DR STE 300
CHICAGO IL
60606-4421
US

IV. Provider business mailing address

109 STATE ST. 5TH FL
BOSTON MA
02109-2906
US

V. Phone/Fax

Practice location:
  • Phone: 617-505-1520
  • Fax: 617-928-8401
Mailing address:
  • Phone: 617-505-1520
  • Fax: 617-928-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number036160939
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number2025-01586
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: