Provider Demographics
NPI:1336340694
Name:MILLINGTON, EIDI K (MD)
Entity Type:Individual
Prefix:DR
First Name:EIDI
Middle Name:K
Last Name:MILLINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 842001
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-2001
Mailing Address - Country:US
Mailing Address - Phone:972-923-7144
Mailing Address - Fax:972-923-7145
Practice Address - Street 1:1405 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165
Practice Address - Country:US
Practice Address - Phone:972-923-7144
Practice Address - Fax:972-923-7145
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP40022712207R00000X
TXM9506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285842501Medicaid
TXP00990906Medicare PIN
TX285842501Medicaid
TXTXB138555Medicare PIN