Healthcare Provider Details

I. General information

NPI: 1811266794
Provider Name (Legal Business Name): MICHAEL ERIC MILEK ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ORTHOPAEDIC PL
ST AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

6765 ARCHING BRANCH CIR
JACKSONVILLE FL
32258-8449
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 1186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: