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Individual

MILTON DAUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7531 SO STONY ISLAND, CHICAGO, IL 60649
(773) 947-7900
(773) 947-7901
Mailing address
4800 S KENWOOD AVE, CHICAGO, IL 60615-2016
(773) 947-7900
(773) 947-7901

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
O36-048434
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0021609983
BLUE CROSS BS
IL
01
O36048434
LICENSE
IL
05
O36048434
IL
Enumeration date
10/20/2006
Last updated
03/04/2013
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