Provider Demographics
NPI:1336882612
Name:MCMILLEN, KYLE RYAN
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:RYAN
Last Name:MCMILLEN
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 1:759 ROSE PENNY LN
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-6355
Mailing Address - Country:US
Mailing Address - Phone:330-354-3064
Mailing Address - Fax:
Practice Address - Street 1:GRAND STRAND MEDICAL CENTER- GME OFFICE
Practice Address - Street 2:809 82ND PARKWAY
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572
Practice Address - Country:US
Practice Address - Phone:843-692-1118
Practice Address - Fax:843-692-1122
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program