Healthcare Provider Details

I. General information

NPI: 1902054547
Provider Name (Legal Business Name): LARRY S. MILNER MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SHERMER RD
NORTHBROOK IL
60062-5340
US

IV. Provider business mailing address

1500 SHERMER RD
NORTHBROOK IL
60062-5340
US

V. Phone/Fax

Practice location:
  • Phone: 847-498-1515
  • Fax: 847-498-2362
Mailing address:
  • Phone: 847-498-1515
  • Fax: 847-498-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number03641209
License Number StateIL

VIII. Authorized Official

Name: DR. LARRY MILNER
Title or Position: PRESIDENT
Credential: MD
Phone: 847-498-1515