Provider Demographics
NPI:1629275037
Name:MILLIKEN, MICHAEL COLIN (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:COLIN
Last Name:MILLIKEN
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 1:6600 BRYANT IRVIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132
Mailing Address - Country:US
Mailing Address - Phone:817-820-0011
Mailing Address - Fax:817-820-0073
Practice Address - Street 1:6600 BRYANT IRVIN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132
Practice Address - Country:US
Practice Address - Phone:817-820-0011
Practice Address - Fax:817-820-0073
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8128676-1205207N00000X
AZ81956207R00000X
MT91667207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine