Provider Demographics
NPI:1912765918
Name:MILL, MICHAEL EUGENE
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:MILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1036
Mailing Address - Country:US
Mailing Address - Phone:417-372-4285
Mailing Address - Fax:
Practice Address - Street 1:906 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2355
Practice Address - Country:US
Practice Address - Phone:417-372-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver