MEDICARE: TARA BROOKE MILHEM RD

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	133V00000X	Registered Dietitian	86033163	NY

General Provider Information

NPI Number	:	1467094854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA BROOKE MILHEM RD

Provider Business Mailing Address
First Line	:	261 HUDSON ST APT 4G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-1563
Country	:	US
Telephone Number	:	305-898-5599
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 HUDSON ST APT 4G
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-1563
Country	:	US
Telephone Number	:	305-898-5599
Fax Number	:

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

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	05/22/2020

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