Healthcare Provider Details

I. General information

NPI: 1265479869
Provider Name (Legal Business Name): MICHELE H MCMILLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 HEALTH PARK STE 213
RALEIGH NC
27615-4731
US

IV. Provider business mailing address

5420 WADE PARK BLVD STE 106
RALEIGH NC
27607-4188
US

V. Phone/Fax

Practice location:
  • Phone: 919-896-7066
  • Fax: 919-896-7067
Mailing address:
  • Phone: 919-233-5952
  • Fax: 919-854-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0097-00069
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: