Provider Demographics
NPI:1073561502
Name:MILLIGAN, MELISSA (PAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1814
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43301-1814
Mailing Address - Country:US
Mailing Address - Phone:740-383-7000
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302
Practice Address - Country:US
Practice Address - Phone:740-383-7000
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPA23162OtherPALMETTO MEDICARE
MIPA23162OtherPALMETTO MEDICARE