Provider Demographics
NPI:1295035608
Name:MILLS, SAMUEL KIRK
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KIRK
Last Name:MILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 WOODWARD AVE
Mailing Address - Street 2:1A
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3123
Mailing Address - Country:US
Mailing Address - Phone:630-774-8310
Mailing Address - Fax:
Practice Address - Street 1:7725 WOODWARD AVE
Practice Address - Street 2:1A
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3123
Practice Address - Country:US
Practice Address - Phone:630-774-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner