Healthcare Provider Details

I. General information

NPI: 1447612627
Provider Name (Legal Business Name): NICOLAS MILLIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BASSWOOD RD
PARAJE NM
87007-1004
US

IV. Provider business mailing address

9270 EAGLE RANCH RD NW APT 1515
ALBUQUERQUE NM
87114-6046
US

V. Phone/Fax

Practice location:
  • Phone: 505-431-0712
  • Fax: 505-552-9454
Mailing address:
  • Phone: 435-525-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80818
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: