Provider Demographics
NPI:1801019880
Name:MILLS, STEVEN R (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:MILLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541A MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1429
Mailing Address - Country:US
Mailing Address - Phone:812-618-1128
Mailing Address - Fax:812-618-3081
Practice Address - Street 1:541A MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1429
Practice Address - Country:US
Practice Address - Phone:812-618-1128
Practice Address - Fax:812-618-3081
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003186A207Q00000X
KY03089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100054100Medicaid
KY7100054100Medicaid