Provider Demographics
NPI:1548240757
Name:MILJOUR, STEVEN RANDOLPH (DO)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:RANDOLPH
Last Name:MILJOUR
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0220
Mailing Address - Country:US
Mailing Address - Phone:906-789-1596
Mailing Address - Fax:906-789-2024
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:STE 401
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-789-1596
Practice Address - Fax:906-789-2024
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010131082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4247445Medicaid
MI260045135OtherRAILROAD MEDICARE
MI0E26035025Medicare PIN
G55909Medicare UPIN
MIP34440012Medicare PIN
MIMI6189001Medicare Oscar/Certification