MEDICARE: DR. MICHELE M. MILLS

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	1223G0001X	General Practice Dentistry	0401410488	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1885668	OTHER	VA	UNITED CONCORDIA PROVIDER
2	247499	OTHER	VA	ANTHEM VA PROVIDER NUMBER

General Provider Information

NPI Number	:	1861519027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE M. MILLS

Provider Business Mailing Address
First Line	:	2111 MILLWHEEL LN
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-4734
Country	:	US
Telephone Number	:	540-387-2855
Fax Number	:

Provider Business Practice Location Address
First Line	:	4572 FRANKLIN RD SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-5144
Country	:	US
Telephone Number	:	540-769-5020
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. MICHELE M. MILLS ” Practice Location

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