Provider Demographics
NPI:1114077708
Name:MILAN, REMIGIO CC (PA)
Entity type:Individual
Prefix:MR
First Name:REMIGIO
Middle Name:CC
Last Name:MILAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923
Mailing Address - Country:US
Mailing Address - Phone:926-361-2500
Mailing Address - Fax:920-361-2973
Practice Address - Street 1:191 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923
Practice Address - Country:US
Practice Address - Phone:926-361-2500
Practice Address - Fax:920-361-2973
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1114077708Medicaid
WI04160127Medicare PIN