Provider Demographics
NPI:1467454637
Name:MCMILLIN, RODNEY D (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:D
Last Name:MCMILLIN
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 1:2100 GARDINER LN STE 207
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2948
Mailing Address - Country:US
Mailing Address - Phone:502-777-9961
Mailing Address - Fax:502-379-8791
Practice Address - Street 1:1 AUDUBON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-777-9961
Practice Address - Fax:502-379-8791
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY18435208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050007OtherANTHEM
KY000000486842OtherANTHEM
KY020017843OtherRAILROAD MEDICARE
KY1049016OtherPASSPORT
KY64184351Medicaid
KYC74680Medicare UPIN
KYK044650Medicare PIN
KY020017843OtherRAILROAD MEDICARE
KY64184351Medicaid