Provider Demographics
NPI:1407015092
Name:LITTLE, MILTON THOMAS MICHAEL (MD BS)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:THOMAS MICHAEL
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MD BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4165
Mailing Address - Country:US
Mailing Address - Phone:310-423-4566
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60325069207XX0801X, 207X00000X
CAA131292207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1407015092Medicaid
WA8919210Medicare PIN