Provider Demographics
NPI:1316960339
Name:MILLS, MARY KATHLENE (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHLENE
Last Name:MILLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1551 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8898
Mailing Address - Country:US
Mailing Address - Phone:918-455-3627
Mailing Address - Fax:918-355-7929
Practice Address - Street 1:1551 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-8898
Practice Address - Country:US
Practice Address - Phone:918-455-3627
Practice Address - Fax:918-355-7929
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101660AMedicaid
OK100101660AMedicaid
248426713Medicare ID - Type Unspecified