Millikin University

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MILLIKIN UNIVERSITY

Doing business as

Millikin University Athletics

Practice address

1184 W Main St
Decatur, IL 62522-2039

Phone

(972) 367-4845

NPI assigned

Feb 10, 2022

Last updated

Feb 10, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mouzon Bass III

Title

Administrator/Agent

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• Millikin University Athletics Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1164176863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY STE 800",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016415",
            "telephone_number": "972-367-4845",
            "fax_number": "972-367-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1184 W MAIN ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625222039",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLIKIN UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-10",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "ADMINISTRATOR/AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Millikin University Athletics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mohamad Minhem, M.D.
• Judy Ann Minton, CNP

• Internal Medicine Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.