MEDICARE: EDWARD L. MILLS M.D.

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	207X00000X	Orthopaedic Surgery Physician	207769	NY

General Provider Information

NPI Number	:	1477546497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD L. MILLS M.D.

Provider Business Mailing Address
First Line	:	833 NORTHERN BLVD
Second Line	:	SUITE 220
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5315
Country	:	US
Telephone Number	:	516-622-7945
Fax Number	:	516-498-9385

Provider Business Practice Location Address
First Line	:	833 NORTHERN BLVD
Second Line	:	SUITE 220
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5315
Country	:	US
Telephone Number	:	516-622-7945
Fax Number	:	516-498-9385

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	04/18/2013

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