Healthcare Provider Details

I. General information

NPI: 1518894583
Provider Name (Legal Business Name): BEND PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW LABICHE LN
BEND OR
97703-6720
US

IV. Provider business mailing address

70 SW CENTURY DR STE 100 PMB 1129
BEND OR
97702
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-2238
  • Fax:
Mailing address:
  • Phone: 541-241-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE MILLS
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 541-419-1663