Healthcare Provider Details

I. General information

NPI: 1164304135
Provider Name (Legal Business Name): KRISTIAN ALEXANDER MILJATOVIC EMT, IDMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51ST MEDICAL GROUP UNIT 2060
APO AP
96278-2060
US

IV. Provider business mailing address

PO BOX 2345
EAGLE ID
83616-9115
US

V. Phone/Fax

Practice location:
  • Phone: 800-874-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: