Healthcare Provider Details

I. General information

NPI: 1467984344
Provider Name (Legal Business Name): DEIRDRE MILLIGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEIRDRE CROKE M.D.

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 CENTRAL PARK VILLAGE DR
EAGAN MN
55121-7707
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W FL 6
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 651-406-8860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number68022
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68022
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: