MEDICARE: DR. MARK ARTHUR MILLEMAN 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	208800000X	Urology Physician	36143	IA
2	208800000X	Urology Physician	036113576	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00260899	OTHER	IA	MEDICARE RAILROAD
6	P00618141	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1464297	OTHER	IA	IA XIX# FOR ILLINOIS PTS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1346229192	OTHER	IL	NPI# UROLOGICAL ASSC PC
5	1346229192	OTHER	IA	NPI# UROLOGICAL ASSC PC

General Provider Information

NPI Number	:	1538162250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ARTHUR MILLEMAN M.D.

Provider Business Mailing Address
First Line	:	3319 SPRING ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2125
Country	:	US
Telephone Number	:	563-359-1641
Fax Number	:	563-359-4634

Provider Business Practice Location Address
First Line	:	3319 SPRING ST
Second Line	:
City	:	DAVENPORT
State	:	IA
Zip	:	52807-2125
Country	:	US
Telephone Number	:	563-359-1641
Fax Number	:	563-359-4634

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	05/08/2013

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Directions to “ DR. MARK ARTHUR MILLEMAN M.D.” Practice Location

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