MEDICARE: DR. CONNIE LEE BILLS D.P.M.

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
1	213E00000X	Podiatrist	5901001836	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5901001836	OTHER	MI	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1225021561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONNIE LEE BILLS D.P.M.

Provider Business Mailing Address
First Line	:	1205 S MISSION ST.
Second Line	:	STE 11
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858
Country	:	US
Telephone Number	:	989-775-8500
Fax Number	:	989-779-1644

Provider Business Practice Location Address
First Line	:	1205 S MISSION ST
Second Line	:	STE 11
City	:	MOUNT PLEASANT
State	:	MI
Zip	:	48858-3939
Country	:	US
Telephone Number	:	989-775-8500
Fax Number	:	989-779-1644

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	03/07/2023

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