Provider Demographics
NPI:1659511947
Name:DANA ELLEN MACMILLAN M D P L L C
Entity Type:Organization
Organization Name:DANA ELLEN MACMILLAN M D P L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:MACMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-336-8275
Mailing Address - Street 1:25600 WOODWARD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0943
Mailing Address - Country:US
Mailing Address - Phone:248-336-8278
Mailing Address - Fax:
Practice Address - Street 1:25600 WOODWARD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0943
Practice Address - Country:US
Practice Address - Phone:248-336-8278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014046412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558497578OtherPERSONAL