Provider Demographics
NPI:1275650954
Name:NEIL S MILLMAN DO PC
Entity Type:Organization
Organization Name:NEIL S MILLMAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-565-7500
Mailing Address - Street 1:27235 JOY RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1022
Mailing Address - Country:US
Mailing Address - Phone:313-565-7500
Mailing Address - Fax:
Practice Address - Street 1:27235 JOY RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1022
Practice Address - Country:US
Practice Address - Phone:313-565-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINM005482207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI111357668Medicaid
MI0858212894OtherBCBS OF MICHIGAN
MIE26454Medicare UPIN
MI0P21850Medicare PIN