Provider Demographics
NPI:1083632988
Name:FLANIGAN, MILLIE (PA)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:PA
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 773621
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80477-3621
Mailing Address - Country:US
Mailing Address - Phone:970-871-8730
Mailing Address - Fax:
Practice Address - Street 1:501 ANGLERS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8840
Practice Address - Country:US
Practice Address - Phone:970-871-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1325363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO477778Medicare ID - Type Unspecified
COP70739Medicare UPIN