Provider Demographics
NPI:1821208455
Name:MILOS TOMICH DPM SC
Entity type:Organization
Organization Name:MILOS TOMICH DPM SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:MILOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-475-9095
Mailing Address - Street 1:7120 W. NORTH AVE.
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213
Mailing Address - Country:US
Mailing Address - Phone:414-475-9095
Mailing Address - Fax:414-475-1898
Practice Address - Street 1:7120 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1811
Practice Address - Country:US
Practice Address - Phone:414-475-9095
Practice Address - Fax:414-475-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI564-025261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43219100Medicaid
WI43219100Medicaid
WI4675740002Medicare NSC
WIT63528Medicare UPIN