1871504167 NPI number — CATHERINE M MACMILLAN DO

Table of content: CATHERINE M MACMILLAN DO (NPI 1871504167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871504167 NPI number — CATHERINE M MACMILLAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACMILLAN
Provider First Name:
CATHERINE
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIRALY
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871504167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8003
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLETON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54912-8003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-996-3200
Provider Business Mailing Address Fax Number:
920-738-5787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LONDON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54961-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-531-2400
Provider Business Practice Location Address Fax Number:
920-531-2450
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  42214 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 450030764 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 711290161 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 30096900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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