MEDICARE: MILAGROS VILLALOBOS MD SC

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	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1636530	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1962511022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILAGROS VILLALOBOS MD SC

Provider Business Mailing Address
First Line	:	2540 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2806
Country	:	US
Telephone Number	:	773-489-5440
Fax Number	:	773-489-5460

Provider Business Practice Location Address
First Line	:	2540 W DIVISION ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-2806
Country	:	US
Telephone Number	:	773-489-5440
Fax Number	:	773-489-5460

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MILAGROS VILLALOBOS
Credential	:	MD
Telephone Number	:	773-489-5440

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/22/2020

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