Provider Demographics
NPI:1295278562
Name:THE MILK SPOT, LLC
Entity type:Organization
Organization Name:THE MILK SPOT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-529-5159
Mailing Address - Street 1:2922 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7705
Mailing Address - Country:US
Mailing Address - Phone:602-529-5159
Mailing Address - Fax:602-265-6644
Practice Address - Street 1:2922 N 18TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7705
Practice Address - Country:US
Practice Address - Phone:602-529-5159
Practice Address - Fax:602-265-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ25151207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty