Provider Demographics
NPI:1548250954
Name:MILAM, MICHAEL MATTHEW (PAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MATTHEW
Last Name:MILAM
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N SWITZER CANYON DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4845
Mailing Address - Country:US
Mailing Address - Phone:928-773-2280
Mailing Address - Fax:928-773-2281
Practice Address - Street 1:525 N SWITZER CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4845
Practice Address - Country:US
Practice Address - Phone:928-773-2280
Practice Address - Fax:928-773-2281
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-2337363AS0400X
WAPA60150118363AS0400X
AZ10423363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0283MIOtherREGENCE
WA1548250954Medicaid
OH415536OtherWELLCARE
WA0264600OtherL&I AND CRIME VICTIMS
OH000000377375OtherANTHEM
AZ200992Medicaid
OHP00726959OtherRAILROAD MEDICARE
WA0283MIOtherREGENCE
WAG8892642Medicare PIN
OHQ52612Medicare UPIN