Provider Demographics
NPI:1508893322
Name:MCMILLAN, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81893 DR CARREON BLVD
Mailing Address - Street 2:SUITE#4
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5592
Mailing Address - Country:US
Mailing Address - Phone:760-775-4181
Mailing Address - Fax:760-775-4818
Practice Address - Street 1:74990 COUNTRY CLUB DR
Practice Address - Street 2:SUITE # 310
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-1991
Practice Address - Country:US
Practice Address - Phone:760-341-8800
Practice Address - Fax:760-775-4818
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC34315207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35582Medicare UPIN