Provider Demographics
NPI:1457392292
Name:MILKOVICH, GARY ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALLEN
Last Name:MILKOVICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6688 RIDGE RD
Mailing Address - Street 2:SUITE 1135
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5706
Mailing Address - Country:US
Mailing Address - Phone:440-845-3811
Mailing Address - Fax:440-845-6151
Practice Address - Street 1:6688 RIDGE RD
Practice Address - Street 2:SUITE 1135
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5706
Practice Address - Country:US
Practice Address - Phone:440-845-3811
Practice Address - Fax:440-845-6151
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34--00-4702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMI0930827Medicaid
OHMI0930827Medicaid
OHF59319Medicare UPIN