Provider Demographics
NPI:1528010238
Name:MILOTT, JOAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:L
Last Name:MILOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11211 W LINCOLN AVE
Mailing Address - Street 2:LINCOLN AVENUE CLINIC
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1035
Mailing Address - Country:US
Mailing Address - Phone:414-955-5900
Mailing Address - Fax:414-327-7639
Practice Address - Street 1:11211 W LINCOLN AVE
Practice Address - Street 2:LINCOLN AVENUE CLINIC
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1035
Practice Address - Country:US
Practice Address - Phone:414-955-5900
Practice Address - Fax:414-327-7639
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28404207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528010238Medicaid
002000127IOtherHUMANA
WI028B73601Medicare PIN
WI1528010238Medicaid