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General NPI Number Information
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NPI Number | 1093412686
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Entity Type | Organization
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Legal Business Name | MJM FAMILY MEDICINE SC
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 900 MAIN ST STE 500
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City | PEORIA
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State | IL
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Zip | 61602-5022
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Country | US
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Telephone | 309-672-4470
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Fax | 309-672-4471
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Provider Business Mailing Address
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Address Line | 900 MAIN ST STE 500
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City | PEORIA
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State | IL
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Zip | 61602-5022
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Country | US
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Telephone | 309-672-4470
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Fax | 309-672-4471
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MATTHEW J MCMILLIN
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Credential | MD
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Telephone | 309-339-3469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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