1376749721 NPI number — JOSHUA A MILLSTEIN D.O.

Table of content: JOSHUA A MILLSTEIN D.O. (NPI 1376749721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376749721 NPI number — JOSHUA A MILLSTEIN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLSTEIN
Provider First Name:
JOSHUA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376749721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746093
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-352-1517
Provider Business Mailing Address Fax Number:
312-929-0393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1940 W INDIAN SCHOOL RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85015-5112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-782-1880
Provider Business Practice Location Address Fax Number:
602-671-6915
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4601 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080683 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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