Basic Information
| Provider Information | |||||||||
| NPI: | 1881635803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILONE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 WILKINS CIR | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826011337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072332700 | ||||||||
| FaxNumber: | 3074661233 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 WILKINS CIR | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826011337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3072332700 | ||||||||
| FaxNumber: | 3074661233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 17770 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 00687 | 01 | NE | BCBSN | OTHER | 10025411900 | 05 | NE | MEDICAID | 47075927913 | 05 | NE | MEDICAID |