Provider Demographics
NPI:1578578258
Name:MARK J. MILONE, M.D., P.C.
Entity Type:Organization
Organization Name:MARK J. MILONE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-397-4144
Mailing Address - Street 1:7710 MERCY RD
Mailing Address - Street 2:#606
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2372
Mailing Address - Country:US
Mailing Address - Phone:402-397-4144
Mailing Address - Fax:402-397-1827
Practice Address - Street 1:7710 MERCY RD
Practice Address - Street 2:#606
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2372
Practice Address - Country:US
Practice Address - Phone:402-397-4144
Practice Address - Fax:402-397-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025411900Medicaid
NE10025411900Medicaid