Provider Demographics
NPI:1407915226
Name:MILLS, DAVID JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG778892085R0203X
MN502962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN134996OtherUCARE
MN1407915226OtherAMERICA'S PPO
MNP00473006OtherRR MEDICARE
MN254738OtherMIDLANDS CHOICE INC
WI34954100Medicaid
MN1407915226OtherMEDICA
IA1407915226Medicaid
MN612627100Medicaid
MN03083COOtherBLUE CROSS AND BLUE SHIELD OF MN
MN960371052306OtherPREFERRED ONE
MNHP79266OtherHEALTHPARTNERS
IA1407915226Medicaid
MN1407915226OtherAMERICA'S PPO
MN254738OtherMIDLANDS CHOICE INC
F92629Medicare UPIN
WI34954100Medicaid
MN300004340Medicare PIN