Provider Demographics
NPI:1578623872
Name:TOMICH, MILOS (DPM)
Entity Type:Individual
Prefix:DR
First Name:MILOS
Middle Name:
Last Name:TOMICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7120 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1811
Mailing Address - Country:US
Mailing Address - Phone:414-475-9095
Mailing Address - Fax:414-475-1898
Practice Address - Street 1:7120 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1811
Practice Address - Country:US
Practice Address - Phone:414-475-9095
Practice Address - Fax:414-475-1898
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI564-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43219100Medicaid
WI000083907Medicare PIN
WIT63528Medicare UPIN
WI43219100Medicaid