MEDICARE: DAVID MILLETT MD

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	2084N0400X	Neurology Physician	A81502	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A815020	OTHER	CA	MEDICAL PPIN #

General Provider Information

NPI Number	:	1437177805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MILLETT MD

Provider Business Mailing Address
First Line	:	7601 IMPERIAL HWY # HB246C
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	310-401-7611
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 IMPERIAL HWY # HB246C
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90242-3456
Country	:	US
Telephone Number	:	310-401-7611
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	09/19/2007

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