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NPI Code Detail

MEDICARE: MR. DOUGLAS R MCMILLIN BD-HIS

MEDICARE: MR. DOUGLAS R MCMILLIN BD-HIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1237700000XHearing Instrument Specialist17000937IN
2237700000XHearing Instrument Specialist1199IL

General Provider Information

NPI Number : 1053568469
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS R MCMILLIN BD-HIS
Provider Business Mailing Address
First Line : 3843 MOLLER RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-2930
Country : US
Telephone Number : 317-291-3376
Fax Number : 317-291-3746
Provider Business Practice Location Address
First Line : 3843 MOLLER RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-2930
Country : US
Telephone Number : 317-291-3376
Fax Number : 317-291-3746
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2008
Last Update Date : 08/27/2008

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