Provider Demographics
NPI:1861636458
Name:MILLS, MICHAEL VERNON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VERNON
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7404 EXECUTIVE PL STE 350
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6268
Mailing Address - Country:US
Mailing Address - Phone:301-599-9500
Mailing Address - Fax:240-542-2959
Practice Address - Street 1:8116 GOOD LUCK RD STE 200
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3508
Practice Address - Country:US
Practice Address - Phone:301-599-9500
Practice Address - Fax:301-552-7483
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48907207XS0117X
390200000X
MDD0083611207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12490700Medicaid