Provider Demographics
NPI:1306835202
Name:MILLMAN, BRUCE IAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:IAN
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:IAN
Other - Last Name:MILLMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2221 LIVERNOIS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1603
Mailing Address - Country:US
Mailing Address - Phone:877-586-4877
Mailing Address - Fax:877-586-4877
Practice Address - Street 1:2221 LIVERNOIS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1603
Practice Address - Country:US
Practice Address - Phone:877-586-4877
Practice Address - Fax:877-586-4877
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM012972207RC0200X
MI5101012972207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14395OtherMCARE
MI4711548Medicaid
MI2956312664OtherBCBS
MIH57094OtherHAP
MI2956312664OtherBLUE CARE NETWORK
MIP00241562OtherRAILROAD MEDICRE
MI14395OtherMCARE
MIH57094OtherHAP