MEDICARE: SEAN ERIC MCMILLAN M.D.

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	207RR0500X	Rheumatology Physician	3571655	ID
2	207RR0500X	Rheumatology Physician	5891032-1205	UT

General Provider Information

NPI Number	:	1558353821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN ERIC MCMILLAN M.D.

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 POLE LINE RD W STE 381
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5810
Country	:	US
Telephone Number	:	208-814-8150
Fax Number	:	208-732-3112

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/24/2025

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Directions to “ SEAN ERIC MCMILLAN M.D.” Practice Location

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