Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 2003014166 | MO |
NPI | 1194837328 |
---|---|
Provider Name | Michael J Milne |
First Address | St. Louis, MO 63150-4871 |
Second Address | Saint Louis, MO 63122-6161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H72874 | (02) |