Basic Information
| Provider Information | |||||||||
| NPI: | 1720377922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULYE | ||||||||
| FirstName: | MILAN | ||||||||
| MiddleName: | DIWAKAR | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MULYE | ||||||||
| OtherFirstName: | MILAN | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5841 S MARYLAND AVE # MC6082 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738340497 | ||||||||
| FaxNumber: | 7738345964 | ||||||||
| Practice Location | |||||||||
| Address1: | 19550 GOVERNORS HWY STE 2500 | ||||||||
| Address2: | |||||||||
| City: | FLOSSMOOR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604222145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087997600 | ||||||||
| FaxNumber: | 7087998848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2011 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD60548135 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 036.134888 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.