Provider Demographics
NPI:1710942537
Name:MILLIGAN, TREY (MD)
Entity Type:Individual
Prefix:
First Name:TREY
Middle Name:
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 1:13801 N WESTERN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1797
Mailing Address - Country:US
Mailing Address - Phone:405-748-0018
Mailing Address - Fax:
Practice Address - Street 1:13801 N WESTERN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1797
Practice Address - Country:US
Practice Address - Phone:405-748-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21346207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100255960AMedicaid
OK100255960BMedicaid
OKH44600Medicare UPIN
OK930128820Medicare PIN
OK242312002Medicare PIN