Provider Demographics
NPI:1982617056
Name:MILANI, MICHAEL HENRY (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HENRY
Last Name:MILANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 WILLOW SPRINGS RD
Mailing Address - Street 2:STE 380
Mailing Address - City:LA GRANGE HIGHLANDS
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6537
Mailing Address - Country:US
Mailing Address - Phone:708-354-2550
Mailing Address - Fax:708-354-4552
Practice Address - Street 1:5201 WILLOW SPRINGS RD
Practice Address - Street 2:STE 380
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6537
Practice Address - Country:US
Practice Address - Phone:708-354-2550
Practice Address - Fax:708-354-4552
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091101208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091101Medicaid
ILG90856Medicare UPIN
IL036091101Medicaid
K22571Medicare PIN