Provider Demographics
NPI:1295736981
Name:MILMAN, IRINA D (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:D
Last Name:MILMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:905 NW 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2137
Mailing Address - Country:US
Mailing Address - Phone:206-931-9957
Mailing Address - Fax:425-353-0722
Practice Address - Street 1:620 SE EVERETT MALL WAY
Practice Address - Street 2:ST. 220
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3278
Practice Address - Country:US
Practice Address - Phone:425-353-0808
Practice Address - Fax:425-353-0722
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042748207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2227182OtherFIRST HEALTH
WA1120534Medicaid
WA6175MIOtherREGENCE
WA1120534Medicaid
WAG8806191Medicare PIN
WAI06130Medicare UPIN