Provider Demographics
NPI:1508053729
Name:MILLS, ALAN D
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:D
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 1:510 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51058-7624
Mailing Address - Country:US
Mailing Address - Phone:712-446-3492
Mailing Address - Fax:712-446-2458
Practice Address - Street 1:510 PINE ST
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:IA
Practice Address - Zip Code:51058-7624
Practice Address - Country:US
Practice Address - Phone:712-446-3492
Practice Address - Fax:712-446-2458
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0449207171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0449207Medicaid