Healthcare Provider Details

I. General information

NPI: 1568464857
Provider Name (Legal Business Name): MICHAEL J MILADORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 BELMONT AVE
YOUNGSTOWN OH
44504-1185
US

IV. Provider business mailing address

1335 BELMONT AVE
YOUNGSTOWN OH
44504-1185
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-2700
  • Fax: 330-747-2211
Mailing address:
  • Phone: 330-747-2700
  • Fax: 330-747-2211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number54953
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: