Provider Demographics
NPI:1265980585
Name:MILLMAN, BRADLEY (PSYD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BANNER BOSWELL MEDICAL CENTER
Mailing Address - Street 2:10401 W. THUNDERBIRD ROAD
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351
Mailing Address - Country:US
Mailing Address - Phone:623-832-3444
Mailing Address - Fax:623-832-3470
Practice Address - Street 1:BANNER BOSWELL MEDICAL CENTER
Practice Address - Street 2:10401 W. THUNDERBIRD ROAD
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351
Practice Address - Country:US
Practice Address - Phone:623-832-3444
Practice Address - Fax:623-832-3470
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016839390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program