Provider Demographics
NPI:1699834705
Name:NEW LIFE CARDIOVASCULAR CARE, P.C.
Entity Type:Organization
Organization Name:NEW LIFE CARDIOVASCULAR CARE, P.C.
Other - Org Name:NEW LIFE CARDIOVASCULAR AND PRIMARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-870-4144
Mailing Address - Street 1:407 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1559
Mailing Address - Country:US
Mailing Address - Phone:215-870-4144
Mailing Address - Fax:215-793-4488
Practice Address - Street 1:805 E WILLOW GROVE AVE STE 1C
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-7968
Practice Address - Country:US
Practice Address - Phone:215-870-4144
Practice Address - Fax:215-793-4488
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW LIFE CARDIOVASCULAR CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-06
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RC0000X, 207UN0901X, 261QM1300X, 261QP2300X
PAMD050825L261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2793777000OtherPERSONAL CHOICE
PA2793777000OtherAMERIHEALTH
PA4206OtherBRAVO
PA001924524OtherBSPA
PA7185016OtherCIGNA
PA30036888OtherKEYSTONE MERCY
PA2793777000OtherKEYSTONE HEALTH PLAN EAST (IBC)
PA7176947OtherAETNA
PA104746Medicare PIN