Healthcare Provider Details

I. General information

NPI: 1528027422
Provider Name (Legal Business Name): MICHAEL DARRELL MILLIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 GULF BREEZE PKWY SUITE 200
GULF BREEZE FL
32561-7808
US

IV. Provider business mailing address

PO BOX 22076
NEW YORK NY
10087-2076
US

V. Phone/Fax

Practice location:
  • Phone: 850-916-3700
  • Fax: 850-916-3710
Mailing address:
  • Phone: 561-657-4709
  • Fax: 561-657-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number11818
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200200257
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME125304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: