| Jack R. Milligan M.d., P.a. | |
|
766 S State St Dover DE 19901-4146 | |
| (302) 735-7730 | |
| (302) 735-4911 |
| Full Name | Jack R. Milligan M.d., P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 766 S State St, Dover, Delaware |
| Authorized Official Name and Position | Jack Milligan (OWNER) |
| Authorized Official Contact | 3027357730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack R. Milligan M.d., P.a. 766 S State St Dover DE 19901-4146 Ph: (302) 735-7730 | Jack R. Milligan M.d., P.a. 766 S State St Dover DE 19901-4146 Ph: (302) 735-7730 |
| NPI Number | 1487670733 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0749329449 |
|---|---|
| Medicare Enrollment ID | O20091209000009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487670733 | NPI | - | NPPES |
| 0001019401 | Medicaid | DE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | C10005866 (Delaware) | Primary |
| Provider Name | Jack R Milligan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659349132 PECOS PAC ID: 3476692336 Enrollment ID: I20091207000031 |
| Provider Name | Kemi F Ogunwusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275116584 PECOS PAC ID: 8224405048 Enrollment ID: I20221109000439 |
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