Provider Demographics
NPI:1437279627
Name:MILAN, PAMELA KAY (RD CDE)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KAY
Last Name:MILAN
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:ROMEO
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4831
Mailing Address - Country:US
Mailing Address - Phone:313-874-6418
Mailing Address - Fax:313-874-9515
Practice Address - Street 1:1 FORD PL # 3A
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-874-6418
Practice Address - Fax:313-874-9515
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
604064133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered