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NPI Code Detail

MEDICARE: MR. JAMES D MILACEK PMHNP

MEDICARE: MR. JAMES D MILACEK PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP6197AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1385954OTHERANCC

General Provider Information

NPI Number : 1386635530
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES D MILACEK PMHNP
Provider Business Mailing Address
First Line : 10000 N 31ST AVE STE C302
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9569
Country : US
Telephone Number : 602-843-0000
Fax Number :
Provider Business Practice Location Address
First Line : 10000 N 31ST AVE STE C302
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-9569
Country : US
Telephone Number : 602-843-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 06/15/2020

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