Basic Information
| Provider Information | |||||||||
| NPI: | 1841727450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLIGAN | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | SPC 5718 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347639251 | ||||||||
| FaxNumber: | 7347634208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | SPC 5718 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347639251 | ||||||||
| FaxNumber: | 7347634208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2017 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301112208 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.