Provider Demographics
NPI:1104050186
Name:JONES, CASSANDRA MCMILLAN (MD)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:MCMILLAN
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CASSANDRA
Other - Middle Name:LEE
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1020 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55411-2504
Mailing Address - Country:US
Mailing Address - Phone:612-302-8200
Mailing Address - Fax:
Practice Address - Street 1:1020 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411
Practice Address - Country:US
Practice Address - Phone:612-302-8200
Practice Address - Fax:612-302-8275
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80022804Medicare PIN