Healthcare Provider Details

I. General information

NPI: 1952797631
Provider Name (Legal Business Name): PHILIP JAMES KASS MILES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 S IOWA ST STE 102
DODGEVILLE WI
53533-1900
US

IV. Provider business mailing address

833 S IOWA ST STE 102
DODGEVILLE WI
53533-1900
US

V. Phone/Fax

Practice location:
  • Phone: 608-935-3301
  • Fax: 608-835-3823
Mailing address:
  • Phone: 608-935-3301
  • Fax: 608-935-3823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5701
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51861
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number66822
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: