Provider Demographics
NPI:1053581371
Name:S L FUENTES MD D M MILANES MD SC
Entity type:Organization
Organization Name:S L FUENTES MD D M MILANES MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILANES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-223-4661
Mailing Address - Street 1:107 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1532
Mailing Address - Country:US
Mailing Address - Phone:847-223-4661
Mailing Address - Fax:847-223-4190
Practice Address - Street 1:107 CENTER ST
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1532
Practice Address - Country:US
Practice Address - Phone:847-223-4661
Practice Address - Fax:847-223-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036032823207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC39049Medicare UPIN