=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932382926
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARY A. MILKOVICH, D.O., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2007
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6044 BROADVIEW RD
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44134-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-563-1003
-----------------------------------------------------
Fax | 216-563-1016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6044 BROADVIEW RD
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44134-3106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-563-1003
-----------------------------------------------------
Fax | 216-563-1016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GARY ALLAN MILKOVICH
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 216-563-1003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------