Provider Demographics
NPI:1629102769
Name:MILLIK, MEHMET (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHMET
Middle Name:
Last Name:MILLIK
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 1:220 RAFT ISLAND DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-5600
Mailing Address - Country:US
Mailing Address - Phone:253-265-8551
Mailing Address - Fax:
Practice Address - Street 1:5920 100TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-588-6694
Practice Address - Fax:253-512-0478
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91280754OtherTAX ID
WA50D1018059OtherCLIA
WAMD00041606OtherSTATE LICENSE
WAMD00041606OtherSTATE LICENSE
WA50D1018059OtherCLIA
WAAB34751Medicare ID - Type Unspecified