Provider Demographics
NPI:1609808492
Name:MILGROM, MARTIN LOUIS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:LOUIS
Last Name:MILGROM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 UNIVERSITY BLVD
Mailing Address - Street 2:UH 4601
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-274-4370
Mailing Address - Fax:317-278-3268
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:UH 4601
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-4370
Practice Address - Fax:317-278-3268
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037956A204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000042347OtherANTHEM
IN0004111316OtherAETNA
IN1437476OtherCIGNA
IN1437476OtherCIGNA
IN074690EMedicare ID - Type Unspecified