Provider Demographics
NPI:1013048057
Name:MILLIKEN, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:MILLIKEN
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 1:224 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2342
Mailing Address - Country:US
Mailing Address - Phone:231-935-0525
Mailing Address - Fax:231-935-0529
Practice Address - Street 1:224 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2342
Practice Address - Country:US
Practice Address - Phone:231-935-0525
Practice Address - Fax:231-935-0529
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052861207RI0008X
MI4301 052861207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10 4680183Medicaid
MI10 4680183Medicaid
MI0P077700001Medicare PIN