MEDICARE: NEW LIFE CARDIOVASCULAR CARE, P.C.

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	207RC0000X	Cardiovascular Disease Physician
2	207UN0901X	Nuclear Cardiology Physician
3	261QM2500X	Medical Specialty Clinic/Center	MD050825L	PA
4	261QP2300X	Primary Care Clinic/Center
5	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30036888	OTHER	PA	KEYSTONE MERCY
2	4206	OTHER	PA	BRAVO
3	2793777000	OTHER	PA	AMERIHEALTH
4	7176947	OTHER	PA	AETNA
5	2793777000	OTHER	PA	KEYSTONE HEALTH PLAN EAST (IBC)
6	2793777000	OTHER	PA	PERSONAL CHOICE
7	001924524	OTHER	PA	BSPA
8	7185016	OTHER	PA	CIGNA

General Provider Information

NPI Number	:	1699834705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LIFE CARDIOVASCULAR CARE, P.C.

Provider Business Mailing Address
First Line	:	407 HIGHGATE DR
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-1559
Country	:	US
Telephone Number	:	215-870-4144
Fax Number	:	215-793-4488

Provider Business Practice Location Address
First Line	:	805 E WILLOW GROVE AVE STE 1C
Second Line	:
City	:	GLENSIDE
State	:	PA
Zip	:	19038-7968
Country	:	US
Telephone Number	:	215-870-4144
Fax Number	:	215-793-4488

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL M MILBOURNE
Credential	:	M.D.
Telephone Number	:	215-870-4144

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	05/16/2024

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