Basic Information
| Provider Information | |||||||||
| NPI: | 1295824738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY T MACMILLAN MD PA | ||||||||
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| OtherOrganizationName: | JEFFREY T MACMILLAN MD PA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9119 W 74TH ST | ||||||||
| Address2: | SUITE 354 | ||||||||
| City: | MERRIAM | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662042215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138942121 | ||||||||
| FaxNumber: | 9138949592 | ||||||||
| Practice Location | |||||||||
| Address1: | 12200 W 106TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662152300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138942121 | ||||||||
| FaxNumber: | 9138949592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 10/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | MACMILLAN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9138942121 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 04-25519 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | DG2851 | 01 | KS | RR MEDICARE GROUP # | OTHER | 100171940A | 05 | KS | MEDICAID | 21793020 | 01 | KS | BCBS KC | OTHER | 200030413 | 01 | KS | MEDICARE RR | OTHER | 208162701 | 05 | MO | MEDICAID |