Healthcare Provider Details

I. General information

NPI: 1376476200
Provider Name (Legal Business Name): VIRIDIAN MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1159 WILMETTE AVE STE 229
WILMETTE IL
60091-2653
US

IV. Provider business mailing address

1159 WILMETTE AVE STE 229
WILMETTE IL
60091-2653
US

V. Phone/Fax

Practice location:
  • Phone: 775-762-9914
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN MCMILLIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 775-762-9914