Healthcare Provider Details

I. General information

NPI: 1801868401
Provider Name (Legal Business Name): MIKE JOSEPH MCMILLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 COLE BLVD STE 100
GOLDEN CO
80401
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 303-763-4900
  • Fax:
Mailing address:
  • Phone: 719-463-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0027594
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: