Provider Demographics
NPI:1053568469
Name:MCMILLIN, DOUGLAS R (BD-HIS)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:R
Last Name:MCMILLIN
Suffix:
Gender:M
Credentials:BD-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 MOLLER RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2930
Mailing Address - Country:US
Mailing Address - Phone:317-291-3376
Mailing Address - Fax:317-291-3746
Practice Address - Street 1:3843 MOLLER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2930
Practice Address - Country:US
Practice Address - Phone:317-291-3376
Practice Address - Fax:317-291-3746
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000937237700000X
IL1199237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist