Provider Demographics
NPI:1104807452
Name:MILLS, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:6465 MILLENNIUM
Practice Address - Street 2:SUITE 100
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7831
Practice Address - Country:US
Practice Address - Phone:517-367-5220
Practice Address - Fax:517-367-5245
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301049237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI204119OtherMCLAREN HEALTH PLAN
MIF05598OtherHEALTH NET FEDERAL SERVIC
MI7720197OtherAETNA
MI0400264OtherPHYSICIANS HEALTH PLAN
MI204119OtherHEALTH ADVANTAGE
MI1103302772OtherBLUE CROSS BLUE SHIELD
MI4130522Medicaid
MI204119OtherHEALTH ADVANTAGE
MI4130522Medicaid