Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02528 | PA |
N | 222Z00000X | Podiatrist | CPO02528 | PA |
Y | 224P00000X | Prosthetist | CPO02528 | PA |
N | 225200000X | Physical Therapy Assistant | TE001848L | PA |
NPI | 1376540666 |
---|---|
Provider Name | Mr. Rick Lee Milen |
First Address | West Lawn, PA 19609-1161 |
Second Address | West Lawn, PA 19609-1161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 14/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1640852 | HIGHMARK (01) | PA |
39HB05 | CAPITAL BLUE CROSS (01) | PA |