Healthcare Provider Details

I. General information

NPI: 1578772570
Provider Name (Legal Business Name): MILROY S EMMANUEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MILROY S EMMANUEL MD

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 N MILWAUKEE AVE SUITE 1
CHICAGO IL
60630-2286
US

IV. Provider business mailing address

4955 N MILWAUKEE AVE SUITE 1
CHICAGO IL
60630-2286
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-3770
  • Fax: 773-736-1403
Mailing address:
  • Phone: 773-736-3770
  • Fax: 773-736-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: