Healthcare Provider Details

I. General information

NPI: 1851365944
Provider Name (Legal Business Name): STEVEN HARRIS MILLMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE STE 110
GLENDALE AZ
85304-1273
US

IV. Provider business mailing address

PO BOX 36581
TUCSON AZ
85740-6581
US

V. Phone/Fax

Practice location:
  • Phone: 623-847-2000
  • Fax:
Mailing address:
  • Phone: 520-544-3007
  • Fax: 520-299-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number192057
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number29031
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21821
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: