Provider Demographics
NPI:1447612627
Name:MILLIGAN, NICOLAS (MD)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9270 EAGLE RANCH RD NW APT 1515
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6046
Mailing Address - Country:US
Mailing Address - Phone:435-525-1828
Mailing Address - Fax:
Practice Address - Street 1:6 BASSWOOD RD
Practice Address - Street 2:
Practice Address - City:PARAJE
Practice Address - State:NM
Practice Address - Zip Code:87007-1004
Practice Address - Country:US
Practice Address - Phone:505-431-0712
Practice Address - Fax:505-552-9454
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA80818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine