Healthcare Provider Details

I. General information

NPI: 1861588352
Provider Name (Legal Business Name): MASON WAYNE MILBURN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S FAIRFIELD AVE
CHICAGO IL
60608
US

IV. Provider business mailing address

909 S MADISON ST
HINSDALE IL
60521-4370
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6663
  • Fax:
Mailing address:
  • Phone: 414-232-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number036125204
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036125204
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: