Provider Demographics
NPI:1639171309
Name:MILLAN, JOSELITO LECAROS (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSELITO
Middle Name:LECAROS
Last Name:MILLAN
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 1:1035 WALL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3612
Mailing Address - Country:US
Mailing Address - Phone:812-283-5739
Mailing Address - Fax:812-283-5739
Practice Address - Street 1:1035 WALL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3612
Practice Address - Country:US
Practice Address - Phone:812-283-5739
Practice Address - Fax:812-283-8631
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023721A207T00000X
KY16465207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
217830Medicare ID - Type Unspecified
C24469Medicare UPIN