Provider Demographics
NPI:1457095804
Name:MILIARA, EVGENIA M (MD)
Entity type:Individual
Prefix:
First Name:EVGENIA
Middle Name:M
Last Name:MILIARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22201 MOROSS RD
Mailing Address - Street 2:SUITE 80
Mailing Address - City:DETRIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48236
Mailing Address - Country:US
Mailing Address - Phone:313-343-3800
Mailing Address - Fax:313-343-4756
Practice Address - Street 1:22201 MOROSS RD STE 70
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2166
Practice Address - Country:US
Practice Address - Phone:313-343-3800
Practice Address - Fax:313-343-4756
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2025-05-28
Deactivation Date:2023-01-23
Deactivation Code:
Reactivation Date:2023-10-02
Provider Licenses
StateLicense IDTaxonomies
MI4301514535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics