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NPI Code Detail

MEDICARE: NORTHERN MICHIGAN GASTROENTEROLOGY PLC

MEDICARE: NORTHERN MICHIGAN GASTROENTEROLOGY PLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0100XGastroenterology Physician4301052861MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P89086OTHERMIBLUE CARE NETWORK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
310 02810491OTHERMIBLUECROSS BLUE SHIELD

General Provider Information

NPI Number : 1659376077
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHERN MICHIGAN GASTROENTEROLOGY PLC
Provider Business Mailing Address
First Line : 224 CIRCLE DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2342
Country : US
Telephone Number : 231-935-0525
Fax Number : 231-935-0529
Provider Business Practice Location Address
First Line : 224 CIRCLE DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2342
Country : US
Telephone Number : 231-935-0525
Fax Number : 231-935-0529
Authorized Official
Title or Position : PRESIDENT
Name : JOHN P MILLIKEN
Credential : M.D.
Telephone Number : 231-935-0525
Provider Enumeration Date : 06/14/2005
Last Update Date : 01/17/2011

Similar Medicare Providers

1588669725 — WILLIAM ARTHUR HOWARD MD
Practice Location Address:
224 CIRCLE DR
TRAVERSE CITY, MI
49684-2342
Practice Phone: 231-932-4855
Practice Fax: 231-932-4850
1659376416 — DAVID BRUCE MACDOUGALL MD
Practice Location Address:
224 CIRCLE DR
TRAVERSE CITY, MI
49684-2342
Practice Phone: 231-932-4855
Practice Fax: 231-932-4850
1932105921 — DR. JOHN OLIVER ZACHMAN M.D.
Practice Location Address:
224 CIRCLE DR
TRAVERSE CITY, MI
49684-2342
Practice Phone: 231-932-4880
Practice Fax: 231-935-0613
1992702567 — MILLIKEN MEDICAL PLLC
Practice Location Address:
224 CIRCLE DR
TRAVERSE CITY, MI
49684-2342
Practice Phone: 231-935-0600
Practice Fax: 231-935-0613
1073544870 — JOHN D FAICHNEY MD
Practice Location Address:
224 CIRCLE DR , SUITE A
TRAVERSE CITY, MI
49684-2342
Practice Phone: 231-935-0545
Practice Fax: 231-935-0857
1013048057 — JOHN P MILLIKEN MD
Practice Location Address:
224 CIRCLE DR
TRAVERSE CITY, MI
49684-2342
Practice Phone: 231-935-0525
Practice Fax: 231-935-0529

Directions to “NORTHERN MICHIGAN GASTROENTEROLOGY PLC ” Practice Location

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