Healthcare Provider Details

I. General information

NPI: 1770633273
Provider Name (Legal Business Name): ERIC MILLSTEIN, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 1204
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

425 HUEHL RD BUILDING 8
NORTHBROOK IL
60062-2319
US

V. Phone/Fax

Practice location:
  • Phone: 310-595-1030
  • Fax: 310-870-7341
Mailing address:
  • Phone: 847-770-6051
  • Fax: 310-870-7341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA78280
License Number StateCA

VIII. Authorized Official

Name: DR. ERIC SETH MILLSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-963-6999