Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 23404 | TN |
NPI | 1225549967 |
---|---|
Provider Name | Bradley Milam |
First Address | Knoxville, TN 37918-5623 |
Second Address | Knoxville, TN 37920-2264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2017 |
Last Update Date | 21/10/2017 |