Provider Demographics
NPI:1568449015
Name:MACMILLAN, JOHN FREDERICK (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:MACMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:SUITE 3400 UNIVERSITY OF CALIFONIA DAVIS SCHOOL OF MEDI
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-794-3564
Mailing Address - Fax:916-734-7924
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:MAIN HOSPITAL UNIVERSITY OF CALIFORNIA DAVIS HEALTH SYS
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:918-734-7508
Practice Address - Fax:918-734-4810
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA688400207R00000X, 208M00000X
CAA68840207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA688400Medicaid
CAA688401Medicare ID - Type Unspecified
CAA688400Medicaid