Provider Demographics
NPI:1225021561
Name:BILLS, CONNIE LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:LEE
Last Name:BILLS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S MISSION ST.
Mailing Address - Street 2:STE 11
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-8500
Mailing Address - Fax:989-779-1644
Practice Address - Street 1:1205 S MISSION ST
Practice Address - Street 2:STE 11
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3939
Practice Address - Country:US
Practice Address - Phone:989-775-8500
Practice Address - Fax:989-779-1644
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001836213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5901001836OtherSTATE LICENSE NUMBER
MI5901001836OtherSTATE LICENSE NUMBER
BB5105906OtherDEA REGISTRATION NUMBER
MIN19440001Medicare PIN