Provider Demographics
NPI:1083829956
Name:MILANCHI, SIAMAK (MD)
Entity Type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:MILANCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIAMAK
Other - Middle Name:
Other - Last Name:MILANCHI ANARKOOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 52435
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-2435
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16300 SAND CANYON AVE STE 604
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3706
Practice Address - Country:US
Practice Address - Phone:949-429-0268
Practice Address - Fax:949-420-2180
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92723208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery