Healthcare Provider Details

I. General information

NPI: 1023167715
Provider Name (Legal Business Name): KATHERINE E MILROY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST STE 302
SAN FRANCISCO CA
94117
US

IV. Provider business mailing address

3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 415-379-2900
  • Fax: 415-666-3144
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA143646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: