Provider Demographics
NPI:1588748891
Name:MCMILLIAN, LOTHAR (MD)
Entity type:Individual
Prefix:
First Name:LOTHAR
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:949-661-1352
Practice Address - Street 1:32312 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4518
Practice Address - Country:US
Practice Address - Phone:949-489-9112
Practice Address - Fax:909-948-7950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45238207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA33-0971357OtherTAX IDENTIFICATION NUMBER
CA00A452380Medicare PIN
CA33-0971357OtherTAX IDENTIFICATION NUMBER