Provider Demographics
NPI:1619196656
Name:MCMILLAN, LEMMON C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEMMON
Middle Name:C
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5718
Mailing Address - Country:US
Mailing Address - Phone:323-750-9715
Mailing Address - Fax:323-750-1532
Practice Address - Street 1:617 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5718
Practice Address - Country:US
Practice Address - Phone:323-750-9715
Practice Address - Fax:323-750-1532
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34897208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice