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General NPI Number Information
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NPI Number | 1538492988
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Entity Type | Organization
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Legal Business Name | BYRON A MILGRAM PROFESSIONAL CORP
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 4121 W 83RD ST 123
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5300
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Country | US
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Telephone | 913-385-5161
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Fax |
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Provider Business Mailing Address
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Address Line | 4121 W 83RD ST 123
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5300
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Country | US
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Telephone | 913-385-5161
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Fax | 913-384-5883
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BYRON A MILGRAM
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Credential | MD
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Telephone | 913-385-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0414349
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License Number State | KS
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