Individual ProviderMilena IvanovaRadiologyAllopathic & Osteopathic PhysiciansPractice Address2160 S 1st Ave, Maywood, IL 60153-3328(708) 216-9000PECOS EnrollmentBased on the most recent information from CMS, provider Milena Ivanova is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1174724264Provider TypeIndividualFull NameIvanova, MilenaTitleDr.CredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date5/29/2007Last Updated5/21/2022Contact InformationPractice LocationPractice Address2160 S 1st Ave, Maywood, IL 60153-3328Phone(708) 216-9000FaxUnlisted FaxMailing LocationMailing Address2160 S 1st Ave, Maywood, IL 60153-3328Phone(708) 216-9000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense036139052IllinoisCode2085R0202XDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseD74734MarylandCode2085R0202XDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense257386MassachusettsCode2085R0202XDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense66154WisconsinProvider IdentifiersIDDescriptionIssuerID058302200DescriptionMedicaidIssuerUnlistedMarylandID1174724264DescriptionMedicaidIssuerUnlistedWisconsin