Provider Demographics
NPI:1740220086
Name:MILLIE, ANNETTE ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:ROSE
Last Name:MILLIE
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 1:831 S WYNN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3527
Mailing Address - Country:US
Mailing Address - Phone:419-693-0793
Mailing Address - Fax:
Practice Address - Street 1:831 S WYNN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3527
Practice Address - Country:US
Practice Address - Phone:419-693-0793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH067198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0198129Medicaid
WV3810027507Medicaid
OHH313880Medicare PIN
OHG15939Medicare UPIN
OH0198129Medicaid
OH4178367Medicare PIN