MEDICARE: DR. BRUCE IAN MILLMAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	5101012972	MI
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	BM012972	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	H57094	OTHER	MI	HAP
3	2956312664	OTHER	MI	BLUE CARE NETWORK
4	14395	OTHER	MI	MCARE
5	2956312664	OTHER	MI	BCBS
6	P00241562	OTHER	MI	RAILROAD MEDICRE

General Provider Information

NPI Number	:	1306835202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE IAN MILLMAN D.O.

Provider Business Mailing Address
First Line	:	141 E 14 MILE RD
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-2171
Country	:	US
Telephone Number	:	248-965-4165
Fax Number	:	248-592-7387

Provider Business Practice Location Address
First Line	:	141 E 14 MILE RD
Second Line	:
City	:	CLAWSON
State	:	MI
Zip	:	48017-2171
Country	:	US
Telephone Number	:	248-965-4165
Fax Number	:	248-592-7387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	01/02/2025

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Directions to “ DR. BRUCE IAN MILLMAN D.O.” Practice Location

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