Provider Demographics
NPI:1063822575
Name:MILGRAM, LIYA
Entity Type:Individual
Prefix:
First Name:LIYA
Middle Name:
Last Name:MILGRAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:541-278-4332
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:1426 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4043
Practice Address - Country:US
Practice Address - Phone:541-431-0000
Practice Address - Fax:541-233-4064
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72086207Q00000X
IL036.144140207Q00000X
ORDO192778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine