Provider Demographics
NPI:1477634541
Name:MILLS, TILLET J (MD)
Entity Type:Individual
Prefix:DR
First Name:TILLET
Middle Name:J
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 11326
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-0126
Mailing Address - Country:US
Mailing Address - Phone:314-692-0111
Mailing Address - Fax:314-692-0126
Practice Address - Street 1:8515 DELMAR BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2168
Practice Address - Country:US
Practice Address - Phone:314-692-0111
Practice Address - Fax:314-692-0126
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMDR9J60207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202785218Medicaid
MO202785218Medicaid