Basic Information
| Provider Information | |||||||||
| NPI: | 1255592135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCMILLEN | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | LARRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 BROOKS LN | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | JEFFERSON HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124691660 | ||||||||
| FaxNumber: | 4124698972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 BROOKS LN | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | JEFFERSON HILLS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150253747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124691660 | ||||||||
| FaxNumber: | 4124698972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 10/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 558 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | SC005983 | PA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.