Provider Demographics
NPI:1659602241
Name:MILUM WOUND CARE, PSC.
Entity Type:Organization
Organization Name:MILUM WOUND CARE, PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-749-3982
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-0732
Mailing Address - Country:US
Mailing Address - Phone:502-749-3982
Mailing Address - Fax:502-749-4990
Practice Address - Street 1:1 AUDUBON PLAZA DR
Practice Address - Street 2:L1 SUITE A481
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1318
Practice Address - Country:US
Practice Address - Phone:502-636-8380
Practice Address - Fax:502-636-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY304092083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty