Provider Demographics
NPI:1912911447
Name:MILLMAN, NEIL S (DO)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22821 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3230
Mailing Address - Country:US
Mailing Address - Phone:248-615-6600
Mailing Address - Fax:
Practice Address - Street 1:22821 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3230
Practice Address - Country:US
Practice Address - Phone:248-615-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINM005482207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0858212894OtherBCBS
MI111357668Medicaid
MI506893OtherCARE CHOICES
MI506893OtherCARE CHOICES
MI111357668Medicaid