Provider Demographics
NPI:1912172776
Name:MILLESS, TIFFANI LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:LYNN
Last Name:MILLESS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4637 121ST ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2311
Mailing Address - Country:US
Mailing Address - Phone:515-655-7080
Mailing Address - Fax:515-655-7090
Practice Address - Street 1:1212 PLEASANT
Practice Address - Street 2:SUITE #LL3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1414
Practice Address - Country:US
Practice Address - Phone:515-241-8861
Practice Address - Fax:515-241-8855
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA40992207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology