Provider Demographics
NPI:1427045665
Name:MILLS, WILLIAM FOWLER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:FOWLER
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 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-362-9518
Practice Address - Street 1:500 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-375-7500
Practice Address - Fax:716-362-9518
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04643400207Q00000X
NY246061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1168304Medicaid
10629OtherAETNA/HMO
0109938000OtherAMERIHEALTH
4248043OtherAETNA PIN
4248043OtherAETNA PIN
NJ1168304Medicaid