Provider Demographics
NPI:1255399366
Name:MILBOURNE, MICHAEL W (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:MILBOURNE
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 1:407 HIGHGATE DR
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-1559
Mailing Address - Country:US
Mailing Address - Phone:215-966-1546
Mailing Address - Fax:
Practice Address - Street 1:805 E WILLOW GROVE AVE
Practice Address - Street 2:STE C11
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-7968
Practice Address - Country:US
Practice Address - Phone:215-966-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050826207R00000X
PAMD050825L207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014939000Medicaid
PA37794MD050825LOtherHEALTH PARTNERS
PA0745998000OtherAMERIHEALTH
PA0745998000OtherKEYSTONE
PA0745998000OtherPERSONAL CHOICE
PA5511627OtherAETNA PPO
PA564071OtherBSPA
PA0745998000OtherAMERIHEALTH
PAF93932Medicare UPIN