MEDICARE: MICKEY O 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	207Q00000X	Family Medicine Physician	D61073	MD

General Provider Information

NPI Number	:	1821095795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICKEY O MILLS M.D.

Provider Business Mailing Address
First Line	:	6400 MARLBORO PIKE
Second Line	:	UPPER LEVEL
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747
Country	:	US
Telephone Number	:	301-736-7000
Fax Number	:	301-736-6916

Provider Business Practice Location Address
First Line	:	6400 MARLBORO PIKE
Second Line	:	UPPER LEVEL
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747
Country	:	US
Telephone Number	:	301-736-7000
Fax Number	:	301-736-6916

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	11/18/2010

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