Provider Demographics
NPI:1376598052
Name:MILANESA, DAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:MICHAEL
Last Name:MILANESA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DANO
Other - Middle Name:M
Other - Last Name:MILANESA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:114 EAST ROMIE LANE
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3126
Mailing Address - Country:US
Mailing Address - Phone:831-422-4500
Mailing Address - Fax:831-422-5195
Practice Address - Street 1:114 EAST ROMIE LANE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3126
Practice Address - Country:US
Practice Address - Phone:831-422-4500
Practice Address - Fax:831-422-5195
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71536208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069270Medicaid
CAZZZ00971ZMedicare ID - Type Unspecified
CAGR0069270Medicaid