Provider Demographics
NPI:1306103205
Name:MILUM WOUND CARE PSC
Entity type:Organization
Organization Name:MILUM WOUND CARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-930-2874
Mailing Address - Street 1:3808 BUGLEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-7437
Mailing Address - Country:US
Mailing Address - Phone:502-930-2874
Mailing Address - Fax:502-339-5700
Practice Address - Street 1:3808 BUGLEWOOD PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-7437
Practice Address - Country:US
Practice Address - Phone:502-930-2874
Practice Address - Fax:502-339-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X
KY30409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64304090Medicaid