Healthcare Provider Details

I. General information

NPI: 1861430365
Provider Name (Legal Business Name): JOHN WILLIAM MILIONIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14045 N 7TH ST STE 2
PHOENIX AZ
85022-4387
US

IV. Provider business mailing address

14045 N 7TH ST STE 2
PHOENIX AZ
85022-4387
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-7311
  • Fax: 602-482-7314
Mailing address:
  • Phone: 602-482-7311
  • Fax: 602-482-7314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2953
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: