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General NPI Number Information
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NPI Number | 1245613082
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Entity Type | Individual
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Provider Name | THEODORE J MILLETTE II MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 1601 CENTER ST
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City | MOBILE
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State | AL
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Zip | 36604-1541
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Country | US
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Telephone | 251-410-5437
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Fax | 251-434-3783
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Provider Business Mailing Address
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Address Line | PO BOX 746450
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City | ATLANTA
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State | GA
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Zip | 30374-6450
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Country | US
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Telephone | 866-401-3057
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Fax | 318-868-6430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | T-3719
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101272247
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 0101272247
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 51881
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License Number State | AL
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