Healthcare Provider Details

I. General information

NPI: 1407375736
Provider Name (Legal Business Name): CHAD PAUL MILLIKAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5327
US

IV. Provider business mailing address

455 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5327
US

V. Phone/Fax

Practice location:
  • Phone: 605-217-7000
  • Fax: 605-217-7015
Mailing address:
  • Phone: 605-217-7000
  • Fax: 605-217-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA110780
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: