| Millikin University Athletics | |
|
1184 W Main St Decatur IL 62522-2039 | |
| (972) 367-4845 | |
| Not Available |
| Full Name | Millikin University Athletics |
|---|---|
| Speciality | Internal Medicine |
| Location | 1184 W Main St, Decatur, Illinois |
| Authorized Official Name and Position | Mouzon Bass (ADMINISTRATOR/AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Millikin University Athletics 15305 Dallas Pkwy Ste 800 Addison TX 75001-6415 Ph: (972) 367-4845 | Millikin University Athletics 1184 W Main St Decatur IL 62522-2039 Ph: (972) 367-4845 |
| NPI Number | 1164176863 |
|---|---|
| Provider Enumeration Date | 02/10/2022 |
| Last Update Date | 02/10/2022 |
| Certification Date | 02/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164176863 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
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