Provider Demographics
NPI:1902138761
Name:MILLETT, CHRISTIAN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:RICHARD
Last Name:MILLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 734240
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-4240
Mailing Address - Country:US
Mailing Address - Phone:708-634-4602
Mailing Address - Fax:571-400-2030
Practice Address - Street 1:2616 SHERWOOD HALL LN STE 306
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3154
Practice Address - Country:US
Practice Address - Phone:571-334-6323
Practice Address - Fax:571-400-2030
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012506368207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology