Provider Demographics
NPI:1164481156
Name:MILLS, MARLIN D (MD)
Entity Type:Individual
Prefix:
First Name:MARLIN
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 S COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6008
Mailing Address - Country:US
Mailing Address - Phone:680-969-5999
Mailing Address - Fax:480-969-5610
Practice Address - Street 1:1940 S COUNTRY CLUB DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6008
Practice Address - Country:US
Practice Address - Phone:680-969-5999
Practice Address - Fax:480-969-5610
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-17370207VM0101X
AZ15324207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ249129Medicaid
NMU3709Medicaid
AZ249129Medicaid
AZ16WCGKW20Medicare ID - Type Unspecified