Healthcare Provider Details

I. General information

NPI: 1407856271
Provider Name (Legal Business Name): SAMUEL LYMON MILLIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 PARK PLACE
MISHAWAKA IN
46545-3519
US

IV. Provider business mailing address

250 E DAY RD SUITE 300
MISHAWAKA IN
46545-3471
US

V. Phone/Fax

Practice location:
  • Phone: 574-273-6787
  • Fax: 574-968-0882
Mailing address:
  • Phone: 574-273-6787
  • Fax: 574-968-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01024383
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: