Provider Demographics
NPI:1962424374
Name:MCMILLAN, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:MCMILLAN
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 1:7070 W 117TH AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2923
Mailing Address - Country:US
Mailing Address - Phone:303-469-3325
Mailing Address - Fax:303-469-3380
Practice Address - Street 1:7070 W 117TH AVE
Practice Address - Street 2:UNIT C
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-2923
Practice Address - Country:US
Practice Address - Phone:303-469-3325
Practice Address - Fax:303-469-3380
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77421736Medicaid