Provider Demographics
NPI:1780632588
Name:MILLS, STEPHEN D (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
Last Name:MILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1332
Mailing Address - Country:US
Mailing Address - Phone:614-741-8285
Mailing Address - Fax:614-392-4630
Practice Address - Street 1:1710 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1332
Practice Address - Country:US
Practice Address - Phone:614-741-8285
Practice Address - Fax:614-392-4630
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0868682Medicaid
OH0709821Medicare PIN
OH3682941Medicare PIN
F17161Medicare UPIN