Basic Information
| Provider Information | |||||||||
| NPI: | 1396027207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 488 | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142400488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039441940 | ||||||||
| FaxNumber: | 2039161041 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 YOUNGS RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166369004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2011 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | 284881-1 | NY | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04826308 | 05 | NY | MEDICAID |