Provider Demographics
NPI:1952797631
Name:MILES, PHILIP JAMES KASS (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES KASS
Last Name:MILES
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 1:833 S IOWA ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-1900
Mailing Address - Country:US
Mailing Address - Phone:608-935-3301
Mailing Address - Fax:608-935-3823
Practice Address - Street 1:833 S IOWA ST STE 102
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1900
Practice Address - Country:US
Practice Address - Phone:608-935-3301
Practice Address - Fax:608-835-3823
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5701207R00000X
IA51861207R00000X
WI66822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1952797631Medicaid