Provider Demographics
NPI:1871868687
Name:MILLIMAN, JESSICA (DPM)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:MILLIMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3315 N RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-4300
Mailing Address - Country:US
Mailing Address - Phone:440-998-0011
Mailing Address - Fax:216-201-7630
Practice Address - Street 1:3909 ORANGE PL STE 2500
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4481
Practice Address - Country:US
Practice Address - Phone:440-998-0011
Practice Address - Fax:216-201-7630
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTBD213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery