Provider Demographics
NPI:1992906978
Name:MCMILLAN, TERRY LEE (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:725 AMERICAN AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5031
Mailing Address - Country:US
Mailing Address - Phone:262-544-2198
Mailing Address - Fax:262-928-5697
Practice Address - Street 1:6400 INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-2452
Practice Address - Country:US
Practice Address - Phone:414-423-4100
Practice Address - Fax:414-423-4134
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2015-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI53256-20207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI681500080Medicare PIN