MEDICARE: DR. MICHAEL M. MILANOVICH D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019022222	IL
2	122300000X	Dentist	35693	TX

General Provider Information

NPI Number	:	1710060637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL M. MILANOVICH D.M.D.

Provider Business Mailing Address
First Line	:	15430 CRUISER ST APT B
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78418-6762
Country	:	US
Telephone Number	:	618-530-6276
Fax Number	:

Provider Business Practice Location Address
First Line	:	5317 S PADRE ISLAND DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-4103
Country	:	US
Telephone Number	:	361-402-6007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/11/2022

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