Provider Demographics
NPI:1972511574
Name:VALUCH, MILAN S (PA)
Entity Type:Individual
Prefix:
First Name:MILAN
Middle Name:S
Last Name:VALUCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-8476
Mailing Address - Fax:812-996-8497
Practice Address - Street 1:751 W 9TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2609
Practice Address - Country:US
Practice Address - Phone:812-996-0400
Practice Address - Fax:812-996-0653
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000265A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000544285OtherANTHEM PIN
IN250470OtherMEDICARE GROUP
IN250470OtherMEDICARE GROUP
R16650Medicare UPIN