Healthcare Provider Details

I. General information

NPI: 1760654297
Provider Name (Legal Business Name): CRAIG J MILHOUSE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E CHAPMAN AVE SUITE 101
ORANGE CA
92866-2139
US

IV. Provider business mailing address

1110 E CHAPMAN AVE SUITE 101
ORANGE CA
92866-2139
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-7272
  • Fax: 714-532-7275
Mailing address:
  • Phone: 714-532-7272
  • Fax: 714-532-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG45457
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG45457
License Number StateCA

VIII. Authorized Official

Name: CRAIG J MILHOUSE
Title or Position: PRESIDENT
Credential: MD
Phone: 714-532-7272