Provider Demographics
NPI:1205922176
Name:VAN MILLIGEN, JAMES M (PA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:VAN MILLIGEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1717 FAIRMOUNT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1919
Mailing Address - Country:US
Mailing Address - Phone:316-617-7535
Mailing Address - Fax:
Practice Address - Street 1:940 S SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2335
Practice Address - Country:US
Practice Address - Phone:316-264-8974
Practice Address - Fax:316-262-4938
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant