MEDICARE: DR. WILLIAM J MILLIKEN 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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	39695	CO

General Provider Information

NPI Number	:	1578552360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J MILLIKEN MD

Provider Business Mailing Address
First Line	:	8010 S COUNTY ROAD 5
Second Line	:	CENTERSTONE SUITE 101
City	:	WINDSOR
State	:	CO
Zip	:	80528-9002
Country	:	US
Telephone Number	:	970-377-1300
Fax Number	:	970-377-1314

Provider Business Practice Location Address
First Line	:	8010 S COUNTY ROAD 5
Second Line	:	CENTERSTONE SUITE 101
City	:	WINDSOR
State	:	CO
Zip	:	80528-9002
Country	:	US
Telephone Number	:	970-377-1300
Fax Number	:	970-377-1314

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	10/09/2009

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