Provider Demographics
NPI:1407856271
Name:MILLIGAN, SAMUEL LYMON (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LYMON
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 E DAY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3471
Mailing Address - Country:US
Mailing Address - Phone:574-273-6787
Mailing Address - Fax:574-968-0882
Practice Address - Street 1:710 PARK PLACE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3519
Practice Address - Country:US
Practice Address - Phone:574-273-6787
Practice Address - Fax:574-968-0882
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01024383207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100326470AMedicaid
IN100326470AMedicaid
IND95587Medicare UPIN