1215920764 NPI number — DR. CREAGH E MILFORD D.O.

Table of content: DR. CREAGH E MILFORD D.O. (NPI 1215920764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215920764 NPI number — DR. CREAGH E MILFORD D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILFORD
Provider First Name:
CREAGH
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215920764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6889 HIGHLAND RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48327-1658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-666-5200
Provider Business Mailing Address Fax Number:
248-666-5069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6889 HIGHLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48327-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-666-5200
Provider Business Practice Location Address Fax Number:
248-666-5069
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  CM006799 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B44586 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C4167 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4573657 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 310F007240 . This is a "BCBSM CMG" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5630642 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F31072 . This is a "BCBSM COMMON PROV ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 106339 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1893975 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103984700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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