Provider Demographics
NPI:1780679050
Name:MACMILLAN, DANIEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:MACMILLAN
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:301 GORDON GUTMANN BLVD STE 401
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3768
Practice Address - Country:US
Practice Address - Phone:812-282-0637
Practice Address - Fax:812-283-6330
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1045231208600000X
KY28148208600000X
IN01045231A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200084530Medicaid
KY28148OtherSTATE LICENSE
IN01045231BOtherCONTROLLED SUBSTANCE REG
KY7100952390Medicaid
IN01045231AOtherSTATE ID #
INE85228Medicare UPIN