Provider Demographics
NPI:1861434276
Name:MILLS, EARL CLARENCE (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:CLARENCE
Last Name:MILLS
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 1:770 W HIGH ST
Mailing Address - Street 2:STE 220
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-5910
Mailing Address - Country:US
Mailing Address - Phone:419-221-3385
Mailing Address - Fax:419-221-3585
Practice Address - Street 1:770 W HIGH ST
Practice Address - Street 2:STE 220
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5910
Practice Address - Country:US
Practice Address - Phone:419-221-3385
Practice Address - Fax:419-221-3585
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087909207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06322OtherPARAMOUNT ADVANTAGE
OH000000488922OtherANTHEM BLUE CROSS & BLUE
OH2658842Medicaid
OH738777OtherBUCKEYE COMMUNITY
OHP00331612OtherRAILROAD MEDICARE
OH7222167OtherAETNA
OHD09454Medicare UPIN
OH2658842Medicaid