MEDICARE: SUSAN G MILLIKEN DO

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	207R00000X	Internal Medicine Physician	157942	MA

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

General Provider Information

NPI Number	:	1912991167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN G MILLIKEN DO

Provider Business Mailing Address
First Line	:	8 COMMERCE BLVD STE 200
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1030
Country	:	US
Telephone Number	:	774-260-9300
Fax Number	:	774-260-9305

Provider Business Practice Location Address
First Line	:	8 COMMERCE BLVD STE 200
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1030
Country	:	US
Telephone Number	:	774-260-9300
Fax Number	:	774-260-9305

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	03/17/2018

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Directions to “ SUSAN G MILLIKEN DO” Practice Location

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