Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 820665 | CA |
NPI | 1003929837 |
---|---|
Provider Name | Milton Krisiloff |
First Address | Santa Monica, CA 90404-2102 |
Second Address | Santa Monica, CA 90404-2102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A41013 | (02) |