Provider Demographics
NPI:1912308065
Name:MILTON, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33717 WOODWARD AVE
Mailing Address - Street 2:#253
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0913
Mailing Address - Country:US
Mailing Address - Phone:313-333-4214
Mailing Address - Fax:248-850-5293
Practice Address - Street 1:33717 WOODWARD AVE
Practice Address - Street 2:#253
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-0913
Practice Address - Country:US
Practice Address - Phone:313-333-4214
Practice Address - Fax:248-850-5293
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4681174H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator