Healthcare Provider Details

I. General information

NPI: 1689663429
Provider Name (Legal Business Name): WILLIAM MILLMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 LAKE ST SUITE 2110
RIVER FOREST IL
60305-1876
US

IV. Provider business mailing address

7411 LAKE ST SUITE 2110
RIVER FOREST IL
60305-1876
US

V. Phone/Fax

Practice location:
  • Phone: 708-488-1122
  • Fax: 708-488-1142
Mailing address:
  • Phone: 708-488-1122
  • Fax: 708-488-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036055855
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: