Individual
MR. MICHAEL MATTHEW MILAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
525 N SWITZER CANYON DR, FLAGSTAFF, AZ 86001-4845
(928) 773-2280
(928) 773-2281
Mailing address
525 N SWITZER CANYON DR, FLAGSTAFF, AZ 86001-4845
(928) 773-2280
(928) 773-2281
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10423
AZ
363AS0400X
Surgical Physician Assistant
50-00-2337
OH
363AS0400X
Surgical Physician Assistant
PA60150118
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000377375
ANTHEM
OH
01
—
0264600
L&I AND CRIME VICTIMS
WA
01
—
0283MI
REGENCE
WA
05
—
1548250954
—
WA
05
—
200992
—
AZ
01
—
415536
WELLCARE
OH
01
—
P00726959
RAILROAD MEDICARE
OH
Enumeration date
10/26/2005
Last updated
11/22/2024
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