Healthcare Provider Details

I. General information

NPI: 1265343917
Provider Name (Legal Business Name): HAROLD J MILLINER II LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 W CAMPUS CIR DR
BERRIEN SPRINGS MI
49103
US

IV. Provider business mailing address

322 E MAIN ST APT 119
NILES MI
49120-2351
US

V. Phone/Fax

Practice location:
  • Phone: 574-386-2177
  • Fax:
Mailing address:
  • Phone: 574-386-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017004
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: