Provider Demographics
NPI:1710757513
Name:MILK MOMS, INC
Entity Type:Organization
Organization Name:MILK MOMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:URAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-314-2096
Mailing Address - Street 1:13783 IBIS ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-7649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1714 BUNKER LAKE BLVD NW STE 102
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-4091
Practice Address - Country:US
Practice Address - Phone:763-314-2004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies