Provider Demographics
NPI:1487693271
Name:MILLIN, MICHAEL ANDREW (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:MILLIN
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 1:3875 TAMARA TRL
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-6161
Mailing Address - Country:US
Mailing Address - Phone:724-983-7970
Mailing Address - Fax:
Practice Address - Street 1:1932 NILES CORTLAND RD NE STE P
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:308-567-7023
Practice Address - Fax:330-856-1096
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34005495207P00000X
PAOS012515207Q00000X
OH34.005495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061843Medicaid
OHP00288742OtherMEDICARE TRAVELERS RR-GA
PAM10839692Medicaid
PA102552777Medicaid
OH942460636408OtherCARESOURCE
PA102552777Medicaid
PA196423Medicare PIN