MEDICARE: PHILLIP MILBOURNE II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1063102614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP MILBOURNE II

Provider Business Mailing Address
First Line	:	5661 3RD ST NE APT 216
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2543
Country	:	US
Telephone Number	:	202-415-2854
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 CATESBY TER
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-5988
Country	:	US
Telephone Number	:	202-415-2854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	06/09/2025

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