Provider Demographics
NPI:1669465589
Name:MILLMAN, JONATHAN B (MD)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:B
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:6701 AIRPORT BLVD
Practice Address - Street 2:SUITE B 218
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6776
Practice Address - Country:US
Practice Address - Phone:251-633-3617
Practice Address - Fax:251-633-9330
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7939207ZP0102X
MS18506207ZP0102X
ALMD.7939207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000039400Medicaid
MS00018252Medicaid
AL39400Medicare ID - Type Unspecified
AL000039400Medicaid