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General NPI Number Information
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NPI Number | 1912533985
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Entity Type | Organization
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Legal Business Name | MILGROM MEDICAL INC.
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 05/26/2020
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Provider Practice Location Address
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Address Line | 1555 VINE ST APT 433S
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City | LOS ANGELES
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State | CA
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Zip | 90028-5298
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Country | US
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Telephone | 720-837-1066
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Fax |
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Provider Business Mailing Address
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Address Line | 1555 VINE ST APT 433S
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City | LOS ANGELES
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State | CA
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Zip | 90028-5298
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | BENJAMIN MILGROM
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Credential | MD
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Telephone | 720-837-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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