MEDICARE: BRUCE MILLMAN, D.O., PLLC

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	BM012972	MI
2	207RP1001X	Pulmonary Disease Physician	5101012972	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	PTAN INDIVI MI591001	OTHER	MI	MEDICARE WPS WISCONSIN FOR MICHIGAN
4	PTAN GROUP DT6533	OTHER		MEDICARE RAILROAD
5	GROUP PTAN IS MI5981	OTHER	MI	MEDICARE WPS WISCONSIN FOR MICHIGAN
6	P00241562	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14395	OTHER	MI	MCARE
3	2956312664	OTHER		BCBS
7	2956312664	OTHER		BLUE CARE NETWORK
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	H57094	OTHER		HAP

General Provider Information

NPI Number	:	1407122575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE MILLMAN, D.O., PLLC

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	:	PHYSICIAN
Name	:	BRUCE IAN MILLMAN
Credential	:	D.O.
Telephone Number	:	248-965-4165

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	09/17/2025

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