Provider Demographics
NPI:1891325866
Name:MILLS, JUDITH MICHELE
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:MICHELE
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 ORCHARD LAKE RD STE 180-250
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1604
Mailing Address - Country:US
Mailing Address - Phone:248-565-7029
Mailing Address - Fax:
Practice Address - Street 1:4900 FAIRWAY RDG S
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3318
Practice Address - Country:US
Practice Address - Phone:248-565-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine