Provider Demographics
NPI:1538492988
Name:BYRON A MILGRAM PROFESSIONAL CORP
Entity Type:Organization
Organization Name:BYRON A MILGRAM PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-385-5161
Mailing Address - Street 1:4121 W 83RD ST
Mailing Address - Street 2:123
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-5300
Mailing Address - Country:US
Mailing Address - Phone:913-385-5161
Mailing Address - Fax:913-384-5883
Practice Address - Street 1:4121 W 83RD ST
Practice Address - Street 2:123
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-5300
Practice Address - Country:US
Practice Address - Phone:913-385-5161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04143492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty