Healthcare Provider Details

I. General information

NPI: 1568664894
Provider Name (Legal Business Name): S J MILLEN, MD.SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11035 W FOREST HOME AVE SUITE 108
HALES CORNERS WI
53130-2541
US

IV. Provider business mailing address

11035 W FOREST HOME AVE SUITE 108
HALES CORNERS WI
53130-2541
US

V. Phone/Fax

Practice location:
  • Phone: 414-529-3215
  • Fax: 414-529-3214
Mailing address:
  • Phone: 414-529-3215
  • Fax: 414-529-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN J MILLEN
Title or Position: NEURO-OTOLOGIST
Credential: M.D.
Phone: 414-529-3215