Provider Demographics
NPI:1861426751
Name:MCMILLIN, KIMBERLY J (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:J
Last Name:MCMILLIN
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 1:5345 N GEORGE BUSH FWY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2767
Mailing Address - Country:US
Mailing Address - Phone:972-495-5888
Mailing Address - Fax:972-495-0588
Practice Address - Street 1:5345 N PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-2767
Practice Address - Country:US
Practice Address - Phone:972-495-5888
Practice Address - Fax:972-495-0588
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86Y596OtherBCBS
TX080169840OtherRR MEDICARE
TX102516502Medicaid
TX102516502Medicaid
TX86Y596Medicare PIN