Basic Information
| Provider Information | |||||||||
| NPI: | 1104827054 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5623 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806342901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703539011 | ||||||||
| FaxNumber: | 9703539135 | ||||||||
| Practice Location | |||||||||
| Address1: | 3519 RICHMOND DR | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805265995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702040300 | ||||||||
| FaxNumber: | 9702269041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0045086 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 91225329 | 05 | CO | MEDICAID |