Healthcare Provider Details

I. General information

NPI: 1740271063
Provider Name (Legal Business Name): RICHARD J MILCHAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ROCKY MOUNTAIN AVE SUITE 300
LOVELAND CO
80538-9004
US

IV. Provider business mailing address

2500 ROCKY MOUNTAIN AVE SUITE 300
LOVELAND CO
80538-9004
US

V. Phone/Fax

Practice location:
  • Phone: 970-619-6100
  • Fax: 970-619-6109
Mailing address:
  • Phone: 970-619-6100
  • Fax: 970-619-6190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDR.0044173
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDR.0044173
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0044173
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: