=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396795100
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC J. MILIE DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 06/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2010 W 38TH ST LOWR LEVEL
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16508-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-868-5481
-----------------------------------------------------
Fax | 814-864-7608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 LECOM PL
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16505-2571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-868-2529
-----------------------------------------------------
Fax | 814-868-2522
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | OS013379
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------