Provider Demographics
NPI:1053400598
Name:MILLS, KEITH R (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:R
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KINGFISHER ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04554
Mailing Address - Country:US
Mailing Address - Phone:307-262-5949
Mailing Address - Fax:844-320-9753
Practice Address - Street 1:20 KINGFISHER ROAD
Practice Address - Street 2:
Practice Address - City:NEW HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04554
Practice Address - Country:US
Practice Address - Phone:307-262-5949
Practice Address - Fax:844-320-9753
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCP206749207RX0202X
WY6639A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116613100Medicaid
B35055Medicare UPIN