Individual
KENNETH REED MCMILLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2020 BLOOMINGTON AVE, MINNEAPOLIS, MN 55404-3073
(612) 813-1610
(612) 813-1612
Mailing address
5618 32ND AVE N, CRYSTAL, MN 55422-2604
(763) 533-1255
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
41394
MN
Other
Enumeration date
03/29/2007
Last updated
07/08/2007
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