MEDICARE: MARY M MILBRATH 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	207Y00000X	Otolaryngology Physician	29484	WI

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	:	1659365534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M MILBRATH MD

Provider Business Mailing Address
First Line	:	19475 W NORTH AVE
Second Line	:	SUITE 301
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4199
Country	:	US
Telephone Number	:	262-780-4444
Fax Number	:	262-780-4329

Provider Business Practice Location Address
First Line	:	19475 W NORTH AVE
Second Line	:	SUITE 301
City	:	BROOKFIELD
State	:	WI
Zip	:	53045-4199
Country	:	US
Telephone Number	:	262-780-4444
Fax Number	:	262-780-4329

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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