Healthcare Provider Details

I. General information

NPI: 1710944954
Provider Name (Legal Business Name): STEVEN J MILLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 02/05/2015
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 Number18990
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: