Provider Demographics
NPI:1669646113
Name:MILO CLINIC
Entity Type:Organization
Organization Name:MILO CLINIC
Other - Org Name:EMIL B MILO MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-224-3069
Mailing Address - Street 1:1305 E TAFT ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6033
Mailing Address - Country:US
Mailing Address - Phone:918-224-3069
Mailing Address - Fax:918-224-3091
Practice Address - Street 1:1305 E TAFT ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6033
Practice Address - Country:US
Practice Address - Phone:918-224-3069
Practice Address - Fax:918-224-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1158950001Medicare NSC