Healthcare Provider Details

I. General information

NPI: 1609939743
Provider Name (Legal Business Name): JEFFREY SCOTT MILEWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 MCLEOD DR S
SAGINAW MI
48604-2827
US

IV. Provider business mailing address

2551 MCLEOD DR S
SAGINAW MI
48604-2827
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-8621
  • Fax:
Mailing address:
  • Phone: 989-799-8620
  • Fax: 989-799-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number5101015270
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number5101015270
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: