Healthcare Provider Details

I. General information

NPI: 1881771947
Provider Name (Legal Business Name): MARGARET L MACMILLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE SE EAST BUILDING JOURNEY CLINIC 9E
MINNEAPOLIS MN
55454
US

IV. Provider business mailing address

420 DELAWARE ST SE, MMC 366 UNIVERSITY OF MINNESOTA PHYSICIANS
MINNEAPOLIS MN
55455
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-8100
  • Fax:
Mailing address:
  • Phone: 612-626-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number41502
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: