MEDICARE: DR. MILROY S EMMANUEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician		IL

General Provider Information

NPI Number	:	1578772570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILROY S EMMANUEL MD

Provider Business Mailing Address
First Line	:	4955 N MILWAUKEE AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60630-2286
Country	:	US
Telephone Number	:	773-736-3770
Fax Number	:	773-736-1403

Provider Business Practice Location Address
First Line	:	4955 N MILWAUKEE AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60630-2286
Country	:	US
Telephone Number	:	773-736-3770
Fax Number	:	773-736-1403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/09/2007

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