Provider Demographics
NPI:1285737569
Name:MILGRAM, PHILLIP MARK (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MARK
Last Name:MILGRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:444 N EL CAMINO REAL SPC 123
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1317
Mailing Address - Country:US
Mailing Address - Phone:760-944-9200
Mailing Address - Fax:760-692-4411
Practice Address - Street 1:3262 HOLIDAY CT STE 210
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1811
Practice Address - Country:US
Practice Address - Phone:760-944-9200
Practice Address - Fax:760-692-4411
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2023-05-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA354112083P0901X, 207QA0401X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A354110Medicare ID - Type Unspecified
CAA27771Medicare UPIN
CAWA35411BMedicare PIN