Doctor Name: | KENNETH REED MCMILLAN |
NPI Number: | 1083734826 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 41394 |
Business Practice Address: | 2020 Bloomington Ave Minneapolis, MN - 554043073 |
Business Phone Number: | 6128131610 |
Business Fax Number: | 6128131612 |
Mailing Address: | 5618 32nd Ave N, CRYSTAL |
State: | MN |
Postal Code: | 554222604 |
Phone Number: | 7635331255 |
Fax Number: | |
NPI Enumeration Date: | 03/29/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 41394 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |