Provider Demographics
NPI:1649834151
Name:MCMILLAN, CHRISTIAN MICHAEL
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:MICHAEL
Last Name:MCMILLAN
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 1:129 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1836
Mailing Address - Country:US
Mailing Address - Phone:518-650-5163
Mailing Address - Fax:
Practice Address - Street 1:129 HAYES RD
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1836
Practice Address - Country:US
Practice Address - Phone:518-650-5163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program