Provider Demographics
NPI:1558794867
Name:EIDI K MILLINGTON MD PA
Entity Type:Organization
Organization Name:EIDI K MILLINGTON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EIDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-282-2416
Mailing Address - Street 1:206A S LOOP 336 W STE W-347
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3300
Mailing Address - Country:US
Mailing Address - Phone:832-282-2416
Mailing Address - Fax:
Practice Address - Street 1:206A S LOOP 336 W STE W-347
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3300
Practice Address - Country:US
Practice Address - Phone:832-282-2416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-10
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9506207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty