Healthcare Provider Details

I. General information

NPI: 1265715700
Provider Name (Legal Business Name): JOEL A MILLINER M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E LEWISTON AVE
FERNDALE MI
48220-1354
US

IV. Provider business mailing address

340 E LEWISTON AVE
FERNDALE MI
48220-1354
US

V. Phone/Fax

Practice location:
  • Phone: 313-570-9041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOEL MILLINER
Title or Position: OWNER
Credential: M.D.
Phone: 313-570-9041