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General NPI Number Information
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NPI Number | 1083640809
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Entity Type | Individual
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Provider Name | JERRY P MILAS D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 1201 RICKER RD
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City | SALEM
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State | IL
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Zip | 62881-4263
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Country | US
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Telephone | 618-548-3194
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Fax | 618-548-8926
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Provider Business Mailing Address
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Address Line | 312 BELMONT CT
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City | MULLICA HILL
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State | NJ
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Zip | 08062-3638
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Country | US
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Telephone | 856-472-0360
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Fax | 815-254-2287
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036-115292
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MB08356300
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License Number State | NJ
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