Healthcare Provider Details

I. General information

NPI: 1689660870
Provider Name (Legal Business Name): MICHELLE DESSA MCMILLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE D MCMILLAN KISH MD

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8054 DARROW RD STE 4
TWINSBURG OH
44087-2381
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-425-3344
  • Fax: 330-425-8847
Mailing address:
  • Phone: 330-342-5555
  • Fax: 330-342-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35064776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: