Healthcare Provider Details

I. General information

NPI: 1790730349
Provider Name (Legal Business Name): ERIN K MILBURN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN K BOHLE PA-C

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FROEDTERT & MED COLLEGE CLIN - EAST 9200 WEST WISCONSIN AVENUE
MILWAUKEE WI
53226
US

IV. Provider business mailing address

10000 W INNOVATION DR
MILWAUKEE WI
53226-4837
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-3666
  • Fax:
Mailing address:
  • Phone: 414-456-5006
  • Fax: 414-456-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1369-023
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: