MEDICARE: MARY MILAM MD

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	207RH0003X	Hematology & Oncology Physician	E4529	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063415735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MILAM MD

Provider Business Mailing Address
First Line	:	1307 8TH AVE
Second Line	:	SUITE 308
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4140
Country	:	US
Telephone Number	:	817-920-0638
Fax Number	:	817-920-0690

Provider Business Practice Location Address
First Line	:	1307 8TH AVE
Second Line	:	SUITE 205
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4137
Country	:	US
Telephone Number	:	817-924-4300
Fax Number	:	817-924-1493

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/15/2008

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Directions to “ MARY MILAM MD” Practice Location

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