Provider Demographics
NPI:1124508122
Name:MILTON, CHADIUS M
Entity type:Individual
Prefix:
First Name:CHADIUS
Middle Name:M
Last Name:MILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18254 LIVERNOIS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-4214
Mailing Address - Country:US
Mailing Address - Phone:313-861-4400
Mailing Address - Fax:313-861-5810
Practice Address - Street 1:18254 LIVERNOIS AVE STE 1
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221
Practice Address - Country:US
Practice Address - Phone:313-861-4400
Practice Address - Fax:313-861-5810
Is Sole Proprietor?:No
Enumeration Date:2018-08-19
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical