MEDICARE: DR. LYNNE H MILGRAM M.D.

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	A35474	CA

General Provider Information

NPI Number	:	1629016316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNNE H MILGRAM M.D.

Provider Business Mailing Address
First Line	:	15395 ISLA VISTA RD
Second Line	:
City	:	JAMUL
State	:	CA
Zip	:	91935-3400
Country	:	US
Telephone Number	:	619-669-3902
Fax Number	:	858-636-2223

Provider Business Practice Location Address
First Line	:	8695 SPECTRUM CENTER BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1489
Country	:	US
Telephone Number	:	858-499-4452
Fax Number	:	858-636-2223

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	07/08/2007

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