Provider Demographics
NPI:1225020142
Name:MAGNANAO, ULYSSES M (DO)
Entity type:Individual
Prefix:DR
First Name:ULYSSES
Middle Name:M
Last Name:MAGNANAO
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9400
Practice Address - Country:US
Practice Address - Phone:847-214-5780
Practice Address - Fax:847-214-5777
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105671Medicaid
IL612034800OtherIL DEPT OF LABOR
IL05632168OtherBLUE CROSS & BLUE SHIELD
ILP01117452OtherRAILROAD MEDICARE PTAN
IL05632414OtherBCBS PROV #
IL1619414OtherBCBS GROUP
ILP00323126Medicare PIN
ILIL2304002Medicare PIN
IL212688Medicare PIN
IL1619414OtherBCBS GROUP
ILP01117452OtherRAILROAD MEDICARE PTAN
IL213035Medicare PIN
ILK17211ICCMedicare PIN
IL05632414OtherBCBS PROV #
IL036105671Medicaid
ILIL2305002Medicare PIN
IL05632168OtherBLUE CROSS & BLUE SHIELD
ILIL7412Medicare UPIN