Provider Demographics
NPI:1316901275
Name:MILLS, DENISE A (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 E FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1586
Mailing Address - Country:US
Mailing Address - Phone:208-895-8670
Mailing Address - Fax:208-955-0494
Practice Address - Street 1:3115 E FLORENCE DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1586
Practice Address - Country:US
Practice Address - Phone:208-895-8670
Practice Address - Fax:208-955-0494
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID80736340004Medicaid
AR20849OtherMD LICENSE
CAG69647OtherMD LICENSE
ID80736340004Medicaid