Provider Demographics
NPI:1699082776
Name:MILLS, MELISSA JANE (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:JANE
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 1:7405 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9414
Mailing Address - Country:US
Mailing Address - Phone:913-588-8400
Mailing Address - Fax:913-588-8529
Practice Address - Street 1:7405 RENNER RD
Practice Address - Street 2:KU MEDWEST
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9414
Practice Address - Country:US
Practice Address - Phone:913-588-8400
Practice Address - Fax:913-588-8529
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5F40207RG0300X
KS04-20763207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100203230CMedicaid
12737090OtherBCBS OF KANSAS CITY
KS100203230CMedicaid