Provider Demographics
NPI:1639161961
Name:MILLET, BRENT L (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:L
Last Name:MILLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 411
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2323
Mailing Address - Country:US
Mailing Address - Phone:610-969-1917
Mailing Address - Fax:484-664-7659
Practice Address - Street 1:2597 SCHOENERSVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7329
Practice Address - Country:US
Practice Address - Phone:610-402-3560
Practice Address - Fax:610-402-3355
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052847L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0734803000OtherKEYSTONE EAST
PA32210OtherGEISINGER
PA0014818100001Medicaid
PA531751OtherKEYSTONE CENTRAL
PAP3626762OtherOXFORD
PA50048433OtherKEYSTONE CENTRAL
PA5248008OtherAETNA
PA531751OtherAMERIHEALTH ADMIN
PA821049OtherFIRST PRIORITY HEALTH
PA50048433OtherBLUE CROSS
PA531751OtherBLUE SHIELD
PA531751OtherAMERIHEALTH ADMIN
PA5248008OtherAETNA