Provider Demographics
NPI:1083769459
Name:SPILLAN, M ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:M ANN
Middle Name:
Last Name:SPILLAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1486
Mailing Address - Country:US
Mailing Address - Phone:231-510-3645
Mailing Address - Fax:406-494-7593
Practice Address - Street 1:830 ALLEN ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1486
Practice Address - Country:US
Practice Address - Phone:231-510-3645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100192084P0800X
MI5101013242084P0800X
CA20A59752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F67162Medicare UPIN