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General NPI Number Information
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NPI Number | 1548250954
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Entity Type | Individual
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Provider Name | MICHAEL MATTHEW MILAM P.A.C.
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 525 N SWITZER CANYON DR
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4845
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Country | US
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Telephone | 928-773-2280
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Fax | 928-773-2281
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Provider Business Mailing Address
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Address Line | 525 N SWITZER CANYON DR
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4845
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Country | US
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Telephone | 928-773-2280
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Fax | 928-773-2281
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 50-00-2337
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA60150118
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10423
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License Number State | AZ
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