Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 4301 052861 | MI |
NPI | 1013048057 |
---|---|
Provider Name | John P Milliken |
First Address | Traverse City, MI 49684-2342 |
Second Address | Traverse City, MI 49684-2342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10 4680183 | (05) | MI |
E49448 | (02) | MI |