Active NPI
Mladen A Milic, PH.D.
- Psychologist
- Wilmington, DE
National Provider Identifier
1700912094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- B1-0000333
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| B1-0000333 | DE | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Norman Broudy | Psychologist | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.