Healthcare Provider Details

I. General information

NPI: 1700017399
Provider Name (Legal Business Name): KENDALL LEE MCMILLIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 WHIRLAWAY DR STE 100
DANVILLE KY
40422-9037
US

IV. Provider business mailing address

478 WHIRLAWAY DR STE 100
DANVILLE KY
40422-9037
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-6613
  • Fax: 859-236-2284
Mailing address:
  • Phone: 859-236-6613
  • Fax: 859-236-2284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number03457
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberUO2217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: