Provider Demographics
NPI:1841652872
Name:MILBURN, SHAWN T (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:T
Last Name:MILBURN
Suffix:
Gender:M
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:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:101 PROSPEROUS PL STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1836
Practice Address - Country:US
Practice Address - Phone:859-275-5229
Practice Address - Fax:859-977-2683
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4140207L00000X
KY53919207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
7617067OtherUNITED HEALTHCARE
KY000001489941OtherANTHEM KY & IN
00297988OtherSIHO
KY68597919OtherAETNA
1327389-0001OtherOHIO WORKERS COMP
KY7100513260Medicaid
12299111OtherPRIME HEALTH SERVICES
IN300047944Medicaid
3787095OtherCIGNA