Individual
MARY GRACE MILAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(540) 815-9015
Mailing address
1720 SANSOM ST UNIT 1, PHILADELPHIA, PA 19103-5207
(540) 815-9015
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MT231982
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/27/2023
Last updated
06/11/2024
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