Basic Information
| Provider Information | |||||||||
| NPI: | 1427045665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | FOWLER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 NIAGARA FALLS BLVD | ||||||||
| Address2: | STE 208 | ||||||||
| City: | N TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166922160 | ||||||||
| FaxNumber: | 7163629518 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | OLEAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7163757500 | ||||||||
| FaxNumber: | 7163629518 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA04643400 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 246061 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1168304 | 05 | NJ | MEDICAID | 10629 | 01 | AETNA/HMO | OTHER | 0109938000 | 01 | AMERIHEALTH | OTHER | 4248043 | 01 | AETNA PIN | OTHER |