Provider Demographics
NPI:1689660870
Name:MCMILLAN, MICHELLE DESSA (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DESSA
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:D
Other - Last Name:MCMILLAN KISH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-342-5555
Mailing Address - Fax:330-342-5651
Practice Address - Street 1:8054 DARROW RD STE 4
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2381
Practice Address - Country:US
Practice Address - Phone:330-425-3344
Practice Address - Fax:330-425-8847
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064776208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics