Provider Demographics
NPI:1679683049
Name:MILLS, ANTHONY MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARTIN
Last Name:MILLS
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 1:9201 W SUNSET BLVD
Mailing Address - Street 2:SUITE 812
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3701
Mailing Address - Country:US
Mailing Address - Phone:310-550-1010
Mailing Address - Fax:310-550-0650
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:STE 812
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3709
Practice Address - Country:US
Practice Address - Phone:310-550-1010
Practice Address - Fax:310-550-0650
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB217748Medicare PIN
CAE50181Medicare UPIN