Provider Demographics
NPI:1316146145
Name:MILHANDER, MARC THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:THOMAS
Last Name:MILHANDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:109 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2655
Mailing Address - Country:US
Mailing Address - Phone:269-683-8972
Mailing Address - Fax:269-683-0449
Practice Address - Street 1:109 N 3RD ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2655
Practice Address - Country:US
Practice Address - Phone:269-683-8972
Practice Address - Fax:269-683-0449
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0A14513Medicare UPIN