Provider Demographics
NPI:1912991167
Name:MILLIKEN, SUSAN G (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 COMMERCE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1030
Mailing Address - Country:US
Mailing Address - Phone:774-260-9300
Mailing Address - Fax:774-260-9305
Practice Address - Street 1:8 COMMERCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1030
Practice Address - Country:US
Practice Address - Phone:774-260-9300
Practice Address - Fax:774-260-9305
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3184838Medicaid
MA3184838Medicaid
MAA28810Medicare ID - Type Unspecified