Third Millennium, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036085478 Issued in IL

Legal business name

THIRD MILLENNIUM, LLC

Practice address

22126 Princeton CT
Frankfort, IL 60423-8510

Phone

(708) 373-0465

NPI assigned

Mar 7, 2014

Organization subpart

No

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

Authorized official

Name

Lance Wallace, MD

Title

President

Phone

(708) 373-0465

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394150400000",
    "number": "1942626478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22126 PRINCETON CT",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604238510",
            "telephone_number": "708-373-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22126 PRINCETON CT",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604238510",
            "telephone_number": "708-373-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD MILLENNIUM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-07",
        "last_updated": "2014-03-07",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-373-0465",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036085478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036085478",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Frankfort, IL
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• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2014; 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.