Individual
DR. THOMAS MILAN MIRICH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 S CHESTNUT ST, SUITE D, ELLENSBURG, WA 98926-4815
(509) 933-8700
(509) 933-8705
Mailing address
611 S CHESTNUT ST, SUITE D, ELLENSBURG, WA 98926-4815
(509) 933-8700
(509) 933-8705
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
11582
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952327025
—
MT
01
—
99366
BLUE CROSS/BLUE SHIELD
MT
01
—
P00465648
MEDICARE RR PTAN
—
Enumeration date
07/14/2006
Last updated
04/15/2016
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