Provider Demographics
NPI:1265682462
Name:MACMILLAN, MARGARET (DO)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:MACMILLAN
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 1:3190 SUNTREE BLVD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5741
Mailing Address - Country:US
Mailing Address - Phone:321-253-2206
Mailing Address - Fax:321-610-7599
Practice Address - Street 1:3190 SUNTREE BLVD.
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5741
Practice Address - Country:US
Practice Address - Phone:321-253-2206
Practice Address - Fax:321-610-7599
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10694207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002660500Medicaid
149QPOtherBCBS
FL002660500Medicaid