Individual
DR. JAMES TONY MILLICAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18101 OAKWOOD BLVD, EMERGENCY MEDICINE DEPARTMENT, DEARBORN, MI 48124-4089
(313) 593-8780
(313) 436-2864
Mailing address
38935 ANN ARBOR RD, CREDENTIALIN/PAYER CONTRACTING, LIVONIA, MI 48150-3397
(734) 632-0175
(734) 632-0182
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301081866
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11614815
CAQH
—
05
—
1639112667
—
MI
Enumeration date
06/14/2006
Last updated
03/21/2012
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