MEDICARE: MICHAEL DARRELL MILLIGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	11818	NV
2	207Q00000X	Family Medicine Physician	200200257	NC
3	207QS0010X	Sports Medicine (Family Medicine) Physician	ME125304	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528027422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DARRELL MILLIGAN MD

Provider Business Mailing Address
First Line	:	PO BOX 22076
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-2076
Country	:	US
Telephone Number	:	561-657-4709
Fax Number	:	561-657-4815

Provider Business Practice Location Address
First Line	:	1040 GULF BREEZE PKWY
Second Line	:	SUITE 200
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-7808
Country	:	US
Telephone Number	:	850-916-3700
Fax Number	:	850-916-3710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/05/2024

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Directions to “ MICHAEL DARRELL MILLIGAN MD” Practice Location

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