Provider Demographics
NPI:1134734973
Name:MCMILLON, ALONZO
Entity type:Individual
Prefix:
First Name:ALONZO
Middle Name:
Last Name:MCMILLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16205 TARKINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3729
Mailing Address - Country:US
Mailing Address - Phone:216-632-7845
Mailing Address - Fax:
Practice Address - Street 1:16205 TARKINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3729
Practice Address - Country:US
Practice Address - Phone:216-632-7845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164926Medicaid