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General NPI Number Information
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NPI Number | 1538574017
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Entity Type | Organization
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Legal Business Name | MILAGROS VILLALOBOS, MD SC
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 3248 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4939
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Country | US
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Telephone | 773-489-5440
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Fax | 773-489-5460
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Provider Business Mailing Address
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Address Line | 3248 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-4939
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Country | US
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Telephone | 773-489-5440
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Fax | 773-489-5460
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. MILAGROS VILLALOBOS
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Credential |
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Telephone | 773-489-5440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036115882
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License Number State | IL
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