Provider Demographics
NPI:1710037619
Name:MCDANIEL, MILLIE M (MD)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:M
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 7TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-3215
Mailing Address - Country:US
Mailing Address - Phone:205-326-6993
Mailing Address - Fax:205-251-2004
Practice Address - Street 1:2316 7TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3215
Practice Address - Country:US
Practice Address - Phone:205-326-6993
Practice Address - Fax:205-251-2004
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL4066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76772Medicare UPIN