=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407122575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRUCE MILLMAN, D.O., PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2012
-----------------------------------------------------
Last Update Date | 09/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 E 14 MILE RD
-----------------------------------------------------
City | CLAWSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48017-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-965-4165
-----------------------------------------------------
Fax | 248-592-7387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 E 14 MILE RD
-----------------------------------------------------
City | CLAWSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48017-2171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-965-4165
-----------------------------------------------------
Fax | 248-592-7387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | BRUCE IAN MILLMAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 248-965-4165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | BM012972
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 5101012972
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------