Provider Demographics
NPI:1952583288
Name:DR RICHARD A MILLS MD PC
Entity type:Organization
Organization Name:DR RICHARD A MILLS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:LILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-839-1000
Mailing Address - Street 1:4007 ORCHARD DR
Mailing Address - Street 2:SUITE 3009
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6102
Mailing Address - Country:US
Mailing Address - Phone:989-839-8881
Mailing Address - Fax:989-839-0094
Practice Address - Street 1:4007 ORCHARD DR
Practice Address - Street 2:SUITE 3009
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6102
Practice Address - Country:US
Practice Address - Phone:989-839-8881
Practice Address - Fax:989-839-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI340E611250OtherBCBS OF MI
MI315904310Medicaid
MI315904310Medicaid
MI0P08280Medicare PIN