Provider Demographics
NPI:1740425719
Name:LOTHAR MCMILLIAN M D INC
Entity Type:Organization
Organization Name:LOTHAR MCMILLIAN M D INC
Other - Org Name:RANCHO FAMILY PRACTICE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOTHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-941-0247
Mailing Address - Street 1:7777 MILLIKEN AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6780
Mailing Address - Country:US
Mailing Address - Phone:909-941-0247
Mailing Address - Fax:909-948-7950
Practice Address - Street 1:7777 MILLIKEN AVE
Practice Address - Street 2:STE 240
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6780
Practice Address - Country:US
Practice Address - Phone:909-941-0247
Practice Address - Fax:909-948-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A452380Medicare PIN