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General NPI Number Information
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NPI Number | 1598511180
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Entity Type | Organization
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Legal Business Name | WILMETTE MEDICAL GROUP, PLLC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 1159 WILMETTE AVE STE 229
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City | WILMETTE
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State | IL
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Zip | 60091-2653
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Country | US
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Telephone | 773-780-0860
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Fax | 773-596-8006
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD # 8259
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 773-780-0860
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Fax | 773-596-8006
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. JOHN ROBERT MCMILLIN
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Credential | MD
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Telephone | 773-780-0860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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