Healthcare Provider Details

I. General information

NPI: 1306835202
Provider Name (Legal Business Name): BRUCE IAN MILLMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRUCE IAN MILLMAN D.O.

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E 14 MILE RD
CLAWSON MI
48017-2171
US

IV. Provider business mailing address

141 E 14 MILE RD
CLAWSON MI
48017-2171
US

V. Phone/Fax

Practice location:
  • Phone: 248-965-4165
  • Fax: 248-592-7387
Mailing address:
  • Phone: 248-965-4165
  • Fax: 248-592-7387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5101012972
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberBM012972
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: