Provider Demographics
NPI:1659349132
Name:MILLIGAN, JACK R (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:R
Last Name:MILLIGAN
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 1:766 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4146
Mailing Address - Country:US
Mailing Address - Phone:302-735-7730
Mailing Address - Fax:302-735-4911
Practice Address - Street 1:766 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4146
Practice Address - Country:US
Practice Address - Phone:302-735-7730
Practice Address - Fax:302-735-4911
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001019401Medicaid
DE0001019401Medicaid
DEH14609Medicare UPIN