Provider Demographics
NPI:1407122575
Name:BRUCE MILLMAN, D.O., PLLC
Entity Type:Organization
Organization Name:BRUCE MILLMAN, D.O., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-586-4877
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBM012972207RC0200X
MI5101012972207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI14395OtherMCARE
MIPTAN INDIVI MI591001OtherMEDICARE WPS WISCONSIN FOR MICHIGAN
2956312664OtherBCBS
PTAN GROUP DT6533OtherMEDICARE RAILROAD
MIGROUP PTAN IS MI5981OtherMEDICARE WPS WISCONSIN FOR MICHIGAN
P00241562OtherRAILROAD MEDICARE
2956312664OtherBLUE CARE NETWORK
MI4711548Medicaid
H57094OtherHAP
PTAN GROUP DT6533OtherMEDICARE RAILROAD