Provider Demographics
NPI:1477558161
Name:MILLIGAN, STEVEN L (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
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 1:916 INDIANA AVE
Mailing Address - Street 2:SUITE120
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3572
Mailing Address - Country:US
Mailing Address - Phone:719-562-1122
Mailing Address - Fax:719-562-0244
Practice Address - Street 1:916 INDIANA AVE
Practice Address - Street 2:STE 120
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3572
Practice Address - Country:US
Practice Address - Phone:719-562-1122
Practice Address - Fax:719-562-0244
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01287010Medicaid
COE40503Medicare UPIN
CO01287010Medicaid