Keenan Milonas M.D. Professional Services PLLC
Family Medicine in Liberty Lake, WA. Organization (NPI-2).
NPI number1013665751
StatusActive
Last updated in NPPESMar 11, 2022
Details
- NPI
- 1013665751
- Entity type
- Organization (NPI-2)
- Legal business name
- Keenan Milonas M.D. Professional Services PLLC
- Organization subpart
- Yes
- Enumeration date
- Mar 11, 2022
- Certification date
- Mar 11, 2022
- Last updated
- Mar 11, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
Other names
- Custom MD (Doing Business As)
- Custom Medicine MD (Doing Business As)
Practice location
2207 N Molter Rd Ste 100Liberty Lake, WA 99019-7571
Phone 509-241-3541 · Fax 509-254-6117
Mailing address
2207 N Molter Rd Ste 100Liberty Lake, WA 99019-7571
Phone 509-241-3541 · Fax 509-254-6117
Authorized official
Ciara Lopez
Assistant Manager
5092413541
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