Healthcare Provider Details

I. General information

NPI: 1013910819
Provider Name (Legal Business Name): CHARLES A MILEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 FREDERICA ST
OWENSBORO KY
42301-5442
US

IV. Provider business mailing address

2780 FREDERICA ST
OWENSBORO KY
42301-5442
US

V. Phone/Fax

Practice location:
  • Phone: 270-926-4100
  • Fax: 270-648-4678
Mailing address:
  • Phone: 270-926-4100
  • Fax: 270-648-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number27488
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: