Keenan Milonas M.D. Professional Services PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

KEENAN MILONAS M.D. PROFESSIONAL SERVICES PLLC

Practice address

2207 N Molter Rd Ste 100
Liberty Lake, WA 99019-7571

Phone

(509) 241-3541

Fax

(509) 254-6117

NPI assigned

Mar 11, 2022

Organization subpart

Yes

Parent organization

KEENAN MILONAS M.D. PROFESSIONAL SERVICES PLLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ciara Lopez

Title

Assistant Manager

Phone

(509) 241-3541

Specialties & licenses 1

Addresses

Other names 2

• CUSTOM MD Doing business as
• CUSTOM MEDICINE MD Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Part of

Keenan Milonas MD PC PLLC

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Keenan Anthony Milonas, MD

  • Family Medicine Physician
  • Liberty Lake, WA
  • NPI 1629364963
  Medicare reassignment NPD
• Natasha K Balani, OD

  • Optometrist
  • Bellevue, WA
  • NPI 1821472499
  NPD
• Daniel Nyle Garn, OD

  • Optometrist
  • Liberty Lake, WA
  • NPI 1952314387
  NPD (past)
• Bret Allen Ulrich, OD

  • Optometrist
  • Liberty Lake, WA
  • NPI 1821001256
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1013665751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 N MOLTER RD STE 100",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197571",
            "telephone_number": "509-241-3541",
            "fax_number": "509-254-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2207 N MOLTER RD STE 100",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990197571",
            "telephone_number": "509-241-3541",
            "fax_number": "509-254-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEENAN MILONAS M.D. PROFESSIONAL SERVICES PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KEENAN MILONAS M.D. PROFESSIONAL SERVICES PLLC",
        "enumeration_date": "2022-03-11",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "CIARA",
        "authorized_official_title_or_position": "ASSISTANT MANAGER",
        "authorized_official_telephone_number": "509-241-3541"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CUSTOM MD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CUSTOM MEDICINE MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly A Juhnke, RDH
• Dana Jwad, DMD
• Lauren E Kalberer, L.M.P.
• Karey Kananda, APRN
• Lisa June Kangas, OTR
• Criswell Allen Kennedy, M.D.
• Kinetic Chiropractic LLC
• Kingsford Physical Therapy and Wellness PLLC
• Braiden Kingsford, DPT
• Leaann P Kinney, PHARMD

• Family Medicine Physician in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.