Provider Demographics
NPI:1144204033
Name:MILIN, BRUCE STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEVEN
Last Name:MILIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:STEVEN
Other - Last Name:MILIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1939 DIVISADERO ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2507
Mailing Address - Country:US
Mailing Address - Phone:415-346-7316
Mailing Address - Fax:847-792-0468
Practice Address - Street 1:1939 DIVISADERO ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2507
Practice Address - Country:US
Practice Address - Phone:415-346-7316
Practice Address - Fax:847-792-0468
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G387460Medicare ID - Type Unspecified
CAA47580Medicare UPIN