Provider Demographics
NPI:1952629644
Name:MCMILLEN, BROCK DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:DALE
Last Name:MCMILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14 TRAFALGAR SQ
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-9515
Mailing Address - Country:US
Mailing Address - Phone:317-412-9190
Mailing Address - Fax:317-878-2302
Practice Address - Street 1:5550 S EAST ST STE C
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1991
Practice Address - Country:US
Practice Address - Phone:317-534-4660
Practice Address - Fax:317-782-4301
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2024-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01072127A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201093710Medicaid
IN068010024Medicare PIN
INP01242714Medicare PIN