Basic Information
| Provider Information | |||||||||
| NPI: | 1700852720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILBACK | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44250 DEQUINDRE RD | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483141002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489640400 | ||||||||
| FaxNumber: | 2489640401 | ||||||||
| Practice Location | |||||||||
| Address1: | 44250 DEQUINDRE RD | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483141002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489640400 | ||||||||
| FaxNumber: | 2489640401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301076952 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080F370780 | 01 | MI | BCBSM | OTHER | 4266932 | 05 | MI | MEDICAID |