Provider Demographics
NPI:1356617617
Name:CARL J. MILKS, MD PC
Entity type:Organization
Organization Name:CARL J. MILKS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MILKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-251-7789
Mailing Address - Street 1:17 BEECH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-4164
Mailing Address - Country:US
Mailing Address - Phone:570-251-7789
Mailing Address - Fax:570-251-9419
Practice Address - Street 1:17 BEECH GROVE RD
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-4164
Practice Address - Country:US
Practice Address - Phone:570-251-7789
Practice Address - Fax:570-251-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018557E207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC30798Medicare UPIN