Provider Demographics
NPI:1053810499
Name:GREGORY S MILLEVILLE, MD, SC
Entity type:Organization
Organization Name:GREGORY S MILLEVILLE, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MILLEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-333-0224
Mailing Address - Street 1:3070 N 51ST ST STE 309
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1661
Mailing Address - Country:US
Mailing Address - Phone:414-333-0224
Mailing Address - Fax:414-447-1070
Practice Address - Street 1:3070 N 51ST ST STE 309
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1661
Practice Address - Country:US
Practice Address - Phone:414-333-0224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI258452080P0006X
WI25845-20282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty