MEDICARE: MICHAEL W MILBOURNE 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	207R00000X	Internal Medicine Physician	MD050826	PA
2	207UN0901X	Nuclear Cardiology Physician	MD050825L	PA
3	207RC0000X	Cardiovascular Disease Physician	MD050825L	PA

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
2	37794MD050825L	OTHER	PA	HEALTH PARTNERS
3	0745998000	OTHER	PA	AMERIHEALTH
4	0745998000	OTHER	PA	KEYSTONE
5	0745998000	OTHER	PA	PERSONAL CHOICE
6	5511627	OTHER	PA	AETNA PPO
7	564071	OTHER	PA	BSPA

General Provider Information

NPI Number	:	1255399366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL W MILBOURNE MD

Provider Business Mailing Address
First Line	:	407 HIGHGATE DR
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-1559
Country	:	US
Telephone Number	:	215-966-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 E WILLOW GROVE AVE
Second Line	:	STE C11
City	:	GLENSIDE
State	:	PA
Zip	:	19038-7968
Country	:	US
Telephone Number	:	215-966-1546
Fax Number	:

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	03/23/2024

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Directions to “ MICHAEL W MILBOURNE MD” Practice Location

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