Provider Demographics
NPI:1720187628
Name:DURST, MILO GERALD (MD)
Entity Type:Individual
Prefix:
First Name:MILO
Middle Name:GERALD
Last Name:DURST
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 1:333 E. WASHINGTON STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-335-4545
Mailing Address - Fax:262-335-6827
Practice Address - Street 1:333 E. WASHINGTON STREET
Practice Address - Street 2:SUITE 2000
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095
Practice Address - Country:US
Practice Address - Phone:262-335-4545
Practice Address - Fax:262-335-6827
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21242-0202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30282000Medicaid
WI30282000Medicaid