Provider Demographics
NPI:1104935188
Name:MILANI, STACEY L (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:MILANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-2600
Mailing Address - Fax:515-643-4733
Practice Address - Street 1:5900 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8457
Practice Address - Country:US
Practice Address - Phone:515-643-2600
Practice Address - Fax:515-643-4733
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0451914Medicaid
IAH90287Medicare UPIN