Healthcare Provider Details

I. General information

NPI: 1457371742
Provider Name (Legal Business Name): HEIDI S. MCMILLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 12TH ST
DURANGO CO
81301-5206
US

IV. Provider business mailing address

10 TOWN PLZ # 237
DURANGO CO
81301-5104
US

V. Phone/Fax

Practice location:
  • Phone: 970-799-5811
  • Fax: 970-797-6460
Mailing address:
  • Phone: 970-799-5811
  • Fax: 970-797-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50159
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9631177
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA
# 2
Identifier12-00960
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED HEALTHCARE
# 3
Identifier107040638101
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerSELECT HEALTH
# 4
Identifier590424112000001
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE CROSS
# 5
Identifier85592
Identifier TypeOTHER
Identifier StateUT
Identifier IssuerPEHP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: