Healthcare Provider Details

I. General information

NPI: 1821208455
Provider Name (Legal Business Name): MILOS TOMICH DPM SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 W NORTH AVE
WAUWATOSA WI
53213-1811
US

IV. Provider business mailing address

7120 W. NORTH AVE.
WAUWATOSA WI
53213
US

V. Phone/Fax

Practice location:
  • Phone: 414-475-9095
  • Fax: 414-475-1898
Mailing address:
  • Phone: 414-475-9095
  • Fax: 414-475-1898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number564-025
License Number StateWI

VIII. Authorized Official

Name: MILOS TOMICH
Title or Position: DPM
Credential: DPM
Phone: 414-475-9095