Provider Demographics
NPI:1467459867
Name:MILLIKEN, JAMES GRAWN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GRAWN
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2342
Mailing Address - Country:US
Mailing Address - Phone:231-932-4903
Mailing Address - Fax:231-935-0613
Practice Address - Street 1:224 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2342
Practice Address - Country:US
Practice Address - Phone:231-932-4903
Practice Address - Fax:231-935-0613
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4154079Medicaid
MI4154079Medicaid
MIOM85930011Medicare PIN