Provider Demographics
NPI:1770633273
Name:ERIC MILLSTEIN, M.D. INC.
Entity Type:Organization
Organization Name:ERIC MILLSTEIN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:MILLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-963-6999
Mailing Address - Street 1:425 HUEHL RD
Mailing Address - Street 2:BUILDING 8
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2319
Mailing Address - Country:US
Mailing Address - Phone:847-770-6051
Mailing Address - Fax:310-870-7341
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-595-1030
Practice Address - Fax:310-870-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78280207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5834060001Medicare NSC
CAH70555Medicare UPIN