MEDICARE: DR. DOUGLAS R MACMILLAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1225241524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS R MACMILLAN DDS

Provider Business Mailing Address
First Line	:	55 E WASHINGTON ST STE 2401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-2217
Country	:	US
Telephone Number	:	312-372-3323
Fax Number	:	312-372-2832

Provider Business Practice Location Address
First Line	:	55 E WASHINGTON ST STE 2401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60602-2217
Country	:	US
Telephone Number	:	312-372-3323
Fax Number	:	312-372-2832

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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