Provider Demographics
NPI:1881635803
Name:MILONE, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MILONE
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 1:1441 WILKINS CIR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1337
Mailing Address - Country:US
Mailing Address - Phone:307-233-2700
Mailing Address - Fax:307-466-1233
Practice Address - Street 1:1441 WILKINS CIR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1337
Practice Address - Country:US
Practice Address - Phone:307-233-2700
Practice Address - Fax:307-466-1233
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17770207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00687OtherBCBSN
NE10025411900Medicaid
NE47075927913Medicaid
277727Medicare ID - Type Unspecified
E66795Medicare UPIN
NE099852Medicare ID - Type UnspecifiedGROUP
NE10025411900Medicaid