Individual provider Active NPI

Mladen A Milic, PH.D.

  • Psychologist
  • Wilmington, DE
National Provider Identifier
1700912094
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
B1-0000333 Issued in DE
Practice address
825 N Washington St
Wilmington, DE 19801-1509
Phone
(302) 655-7110
Fax
(302) 655-6185
NPI assigned
Feb 23, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X B1-0000333 DE Primary

Addresses

Primary practice location

825 N Washington St
Wilmington, DE 19801-1509

Mailing address

656 N 15TH St
Philadelphia, PA 19130-2927
Phone (215) 236-6761

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210419001504 PA Practitioner - Clinical Psychologist 1557421765 Practice locations: Philadelphia, PA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
B1-0000333DEMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Norman Broudy Psychologist CurrentSince Oct 20, 2024 Accepting new patients

Locations

825 N Washington St
Wilmington, DE 19801
Phone (302) 655-7110

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700912094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "656 N 15TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191302927",
            "telephone_number": "215-236-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 N WASHINGTON ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198011509",
            "telephone_number": "302-655-7110",
            "fax_number": "302-655-6185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILIC",
        "first_name": "MLADEN",
        "middle_name": "A",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "DE",
            "license": "B1-0000333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

Verify at the official NPI Registry.