Provider Demographics
NPI:1386812428
Name:MILA-MARIE KYNCL, MD, SC
Entity type:Organization
Organization Name:MILA-MARIE KYNCL, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-662-7788
Mailing Address - Street 1:700 S LEWIS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6100
Mailing Address - Country:US
Mailing Address - Phone:847-662-7788
Mailing Address - Fax:847-662-7817
Practice Address - Street 1:700 S LEWIS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-6100
Practice Address - Country:US
Practice Address - Phone:847-662-7788
Practice Address - Fax:847-662-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG17313Medicare UPIN
ILD89341Medicare UPIN