Provider Demographics
NPI:1790746154
Name:SAMANIEGO-PICOTA, MILAGROS DALGIR (MD)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:DALGIR
Last Name:SAMANIEGO-PICOTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MILLIE
Other - Middle Name:
Other - Last Name:SAMANIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DR
Practice Address - Street 2:3RD FLOOR TAUBMAN CENTER RECP C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5364
Practice Address - Country:US
Practice Address - Phone:734-936-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093628207R00000X, 207RN0300X
WI46860207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34522000Medicaid
G31312Medicare UPIN
MIG31312Medicare UPIN
WI034F15875Medicare ID - Type Unspecified