1306401484 NPI number — KATRINA M MILLIKEN PLLC

Table of content: (NPI 1306401484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306401484 NPI number — KATRINA M MILLIKEN PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATRINA M MILLIKEN PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRACE BEHAVIORAL HEALTH OF MICHIGAN
Provider Other Organization Name Type Code:
3
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:
1306401484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
572 PLEASANT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREGORY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48137-9580
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-978-3584
Provider Business Mailing Address Fax Number:
248-592-7240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 W MIDDLE ST STE I
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHELSEA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48118-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-491-8840
Provider Business Practice Location Address Fax Number:
248-592-7240
Provider Enumeration Date:
05/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MILLIKEN
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
248-978-3584

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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