Organization
NORTHERN MICHIGAN GASTROENTEROLOGY PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN P MILLIKEN M.D. (PRESIDENT)
(231) 935-0525
Entity
Organization
Contact information
Practice address
224 CIRCLE DR, TRAVERSE CITY, MI 49684-2342
(231) 935-0525
(231) 935-0529
Mailing address
224 CIRCLE DR, TRAVERSE CITY, MI 49684-2342
(231) 935-0525
(231) 935-0529
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
4301052861
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10 02810491
BLUECROSS BLUE SHIELD
MI
05
—
10 4680183
—
MI
01
—
P89086
BLUE CARE NETWORK
MI
Enumeration date
06/14/2005
Last updated
01/17/2011
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