Provider Demographics
NPI:1467459867
Name:MILLIKEN, JAMES GRAWN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GRAWN
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:231-932-4903
Mailing Address - Fax:231-935-0613
Practice Address - Street 1:419 S CORAL ST
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646-2503
Practice Address - Country:US
Practice Address - Phone:231-258-7777
Practice Address - Fax:231-258-7786
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039405207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4154079Medicaid
MI4154079Medicaid
MIOM85930011Medicare PIN