Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036043424 | IL |
NPI | 1003808411 |
---|---|
Provider Name | Dr. Robert Wayne Milas |
First Address | Rock Island, IL 61201-3907 |
Second Address | Rock Island, IL 61201-3907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 12/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036043424 | (05) | IL |
0949669 | (05) | IA |
D09794 | (02) | IL |