Provider Demographics
NPI:1023734951
Name:MILLIE MEDICAL OF KANSAS, P.A.
Entity type:Organization
Organization Name:MILLIE MEDICAL OF KANSAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAKODETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-432-5841
Mailing Address - Street 1:PO BOX 780298
Mailing Address - Street 2:73799
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12022 BLUE VALLEY PKWY STE 523
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2647
Practice Address - Country:US
Practice Address - Phone:561-476-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty