Basic Information
| Provider Information | |||||||||
| NPI: | 1417596271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILTON | ||||||||
| FirstName: | SEDRICK | ||||||||
| MiddleName: | TERRELL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8326 KELWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708064803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2259299783 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 51472 HARRISON MILTON LN | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704432269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9859748983 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2019 | ||||||||
| LastUpdateDate: | 12/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/26/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | LA | Y |
No ID Information.