Healthcare Provider Details

I. General information

NPI: 1659602241
Provider Name (Legal Business Name): MILUM WOUND CARE, PSC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON PLAZA DR L1 SUITE A481
LOUISVILLE KY
40217-1318
US

IV. Provider business mailing address

PO BOX 732
CRESTWOOD KY
40014-0732
US

V. Phone/Fax

Practice location:
  • Phone: 502-636-8380
  • Fax: 502-636-8385
Mailing address:
  • Phone: 502-749-3982
  • Fax: 502-749-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number30409
License Number StateKY

VIII. Authorized Official

Name: JOSEPH A MILUM
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 502-749-3982