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Individual

CATHERINE M MACMILLAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
1405 MILL ST, NEW LONDON, WI 54961-2155
(920) 531-2400
(920) 531-2450
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3200
(920) 738-5787

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42214
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30096900
WI
01
450030764
MEDICARE PTAN
WI
01
711290161
MEDICARE PTAN
WI
Enumeration date
08/11/2006
Last updated
03/13/2012
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