Provider Demographics
NPI:1063415347
Name:MCMILLAN, EDROY L (MD)
Entity type:Individual
Prefix:DR
First Name:EDROY
Middle Name:L
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4103
Mailing Address - Country:US
Mailing Address - Phone:419-756-6000
Mailing Address - Fax:419-756-1774
Practice Address - Street 1:500 S TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4103
Practice Address - Country:US
Practice Address - Phone:419-756-6000
Practice Address - Fax:419-756-8721
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061717207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0828831Medicaid
OHE96341Medicare UPIN
OH0828831Medicaid