Provider Demographics
NPI:1568464857
Name:MILADORE, MICHAEL J (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:MILADORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1185
Mailing Address - Country:US
Mailing Address - Phone:330-747-2700
Mailing Address - Fax:330-747-2211
Practice Address - Street 1:1335 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1185
Practice Address - Country:US
Practice Address - Phone:330-747-2700
Practice Address - Fax:330-747-2211
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH54953174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0664713Medicaid
OH0664713Medicaid
OHA16811Medicare UPIN