1659602241 NPI number — MILUM WOUND CARE, PSC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659602241 NPI number — MILUM WOUND CARE, PSC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILUM WOUND CARE, PSC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659602241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 732
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40014-0732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-749-3982
Provider Business Mailing Address Fax Number:
502-749-4990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 AUDUBON PLAZA DR
Provider Second Line Business Practice Location Address:
L1 SUITE A481
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-8380
Provider Business Practice Location Address Fax Number:
502-636-8385
Provider Enumeration Date:
01/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MILUM
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
502-749-3982

Provider Taxonomy Codes

  • Taxonomy code: 2083P0011X , with the licence number:  30409 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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