Provider Demographics
NPI:1558658203
Name:MCMILLAN, JOSEPH MICHAEL
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:MCMILLAN
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 1:172 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAND POINT
Mailing Address - State:AK
Mailing Address - Zip Code:99661-0172
Mailing Address - Country:US
Mailing Address - Phone:907-383-3151
Mailing Address - Fax:907-383-5688
Practice Address - Street 1:3380 C STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3949
Practice Address - Country:US
Practice Address - Phone:907-277-1440
Practice Address - Fax:907-277-1436
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker