Healthcare Provider Details

I. General information

NPI: 1184685307
Provider Name (Legal Business Name): GREGORY SCOTT MILLEVILLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 04/08/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17345 CIVIC DR STE 1327
BROOKFIELD WI
53045-1645
US

IV. Provider business mailing address

PO BOX 1327
BROOKFIELD WI
53008-1327
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-7730
  • Fax: 414-447-1070
Mailing address:
  • Phone: 414-447-7730
  • Fax: 414-447-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25845
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: