Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 036118282 | IL |
N | 2084N0600X | Clinical Neurophysiologist | 036118282 | IL |
NPI | 1225211600 |
---|---|
Provider Name | Dr. John Joseph Millichap |
First Address | Denver, CO 80204-4507 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2007 |
Last Update Date | 16/11/2021 |