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General NPI Number Information
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NPI Number | 1760832117
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Entity Type | Individual
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Provider Name | LACEY MCMILLAN MD
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Gender | Female
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 630 S FLEISHEL AVE
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City | TYLER
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State | TX
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Zip | 75701-2041
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Country | US
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Telephone | 903-606-5560
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Fax |
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Provider Business Mailing Address
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Address Line | 27617 TIERRA DEL SOL LN
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-3553
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Country | US
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Telephone | 305-619-1680
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Fax |
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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 | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | 1017531
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | 1017531
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | TRN23830
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | ME148659
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License Number State | FL
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