Provider Demographics
NPI:1013945492
Name:MILLS, STEPHEN J (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:MILLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012
Mailing Address - Country:US
Mailing Address - Phone:215-379-3030
Mailing Address - Fax:215-379-3043
Practice Address - Street 1:421 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHELTENHAM
Practice Address - State:PA
Practice Address - Zip Code:19012
Practice Address - Country:US
Practice Address - Phone:215-379-3030
Practice Address - Fax:215-379-3043
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001443L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0506128Medicaid
T29614Medicare UPIN
PA0506128Medicaid