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General NPI Number Information
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NPI Number | 1548780844
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Entity Type | Individual
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Provider Name | MANDALYN J MILLS DO
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Gender | Female
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 802 N RIVERSIDE RD STE G50
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City | SAINT JOSEPH
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State | MO
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Zip | 64507-2510
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Country | US
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Telephone | 816-671-4888
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Fax | 816-671-4890
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Provider Business Mailing Address
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Address Line | 5301 FARAON ST STE 120
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3512
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Country | US
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Telephone | 816-671-4888
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Fax | 816-671-4890
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 5101023019
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2022016390
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License Number State | MO
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