Provider Demographics
NPI:1154592053
Name:MILANOVICH, JOHN ROBERT (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:MILANOVICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 COMMONWEALTH BLVD
Mailing Address - Street 2:#205
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2947
Mailing Address - Country:US
Mailing Address - Phone:734-222-0201
Mailing Address - Fax:734-222-0234
Practice Address - Street 1:2001 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2947
Practice Address - Country:US
Practice Address - Phone:734-222-0201
Practice Address - Fax:734-222-0234
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010984103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist