Provider Demographics
NPI:1457371742
Name:MCMILLAN, HEIDI S (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:S
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10 TOWN PLZ # 237
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5104
Mailing Address - Country:US
Mailing Address - Phone:970-799-5811
Mailing Address - Fax:970-797-6460
Practice Address - Street 1:215 E 12TH ST
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5206
Practice Address - Country:US
Practice Address - Phone:970-799-5811
Practice Address - Fax:970-797-6460
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50159208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
9631177OtherCIGNA
12-00960OtherUNITED HEALTHCARE
UT107040638101OtherSELECT HEALTH
590424112000001OtherBLUE CROSS
UT85592OtherPEHP
UT85592OtherPEHP