Provider Demographics
NPI:1538166277
Name:MILLMAN, MARSHALL S (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:S
Last Name:MILLMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0299
Mailing Address - Country:US
Mailing Address - Phone:931-728-5607
Mailing Address - Fax:931-728-8354
Practice Address - Street 1:2345 MURFREESBORO HWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3206
Practice Address - Country:US
Practice Address - Phone:931-728-5607
Practice Address - Fax:931-728-8354
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24195207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0153432OtherBLUE SHIELD
TN3073209Medicaid
TN2012585OtherAETNA HMO
TN2282875003OtherCIGNA PLAN 139
TN0522OtherHEALTH 123
TN2040214OtherUNITED HEALTHCARE
TN2282875004OtherCIGNA PLAN 110
TN4086511OtherAETNA PPO
TN3073200Medicare ID - Type Unspecified
TN3073209Medicaid