Healthcare Provider Details

I. General information

NPI: 1902834666
Provider Name (Legal Business Name): MICHAEL MACMILLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 W NEWBERRY RD SUITE 2
GAINESVILLE FL
32607-2817
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-7246
  • Fax: 352-224-2220
Mailing address:
  • Phone: 352-547-2373
  • Fax: 352-291-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME40587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: