Provider Demographics
NPI:1649205618
Name:MILFORD FAMILY PHYSICIANS, LLP
Entity Type:Organization
Organization Name:MILFORD FAMILY PHYSICIANS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-658-4142
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:IN
Mailing Address - Zip Code:46542-0128
Mailing Address - Country:US
Mailing Address - Phone:574-658-4142
Mailing Address - Fax:574-658-3160
Practice Address - Street 1:201 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:IN
Practice Address - Zip Code:46542-0128
Practice Address - Country:US
Practice Address - Phone:574-658-4142
Practice Address - Fax:574-658-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000112477OtherBCBS GROUP NUMBER
000000112477OtherBCBS GROUP NUMBER
IN451990Medicare PIN