Basic Information
| Provider Information | |||||||||
| NPI: | 1669437539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILTICH | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | FIEGEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953468 | ||||||||
| Practice Location | |||||||||
| Address1: | 10512 PARK RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953650 | ||||||||
| FaxNumber: | 7042953666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 05/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 26963 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 10470 | 01 | NC | KANAWHA | OTHER | 561896112K | 01 | NC | CIGNA | OTHER | N26963 | 05 | SC | MEDICAID | 141012 | 01 | NC | COVENTRY | OTHER | 4024096 | 01 | NC | AETNA | OTHER | 6197 | 01 | NC | DOCTORS HEALTH PLAN | OTHER | 276577 | 01 | NC | MAMSI | OTHER | 28217 | 01 | NC | MEDCOST | OTHER | 000000260101 | 01 | SC | UNISON HEALTH PLAN SC | OTHER | 1041441 | 01 | NC | UNITED HEALTHCARE | OTHER | 7105 | 01 | NC | WELLPATH | OTHER | 20034344 | 01 | SC | SELECT HEALTH OF SC | OTHER | 100765 | 01 | NC | WELLNESS | OTHER | 8959509 | 05 | NC | MEDICAID | 59509 | 01 | NC | BCBS | OTHER | 6864 | 01 | NC | PARTNERS | OTHER |